Is the NHS getting better or worse?

Editor—Smith's editorial asks an important question about whether the NHS is getting better.¹ He places a lot of faith in gathering better data about the workings of the NHS to help us answer this question.

However, this approach begs the question of “what would the appropriate data be?” And behind that is the intensely political question of, “Just who gets to select the data?”

Data have the facade of being somehow neutral and objective. Data may be seen as factual, and figures may seem to add up. However, the real smoke and mirrors trick has already been laid by the person who has chosen the frames of reference around which data are to be selected. We may have been set up by this frame to react in a predictable way, even before any data are presented.

Behind even the simplest data someone in the background is choosing to highlight some facts, and to fade others out. As we do not have an agreed idea about what a working NHS would consist of, any statements such as “the NHS is working” or “the NHS is not working” at present have no clear meaning, and serve largely as political slogans rather than debatable propositions.

We need first to decide what we would mean by a “working NHS” and then choose what data would give us the measure of our concept. Both doctors and patients need to make their concept far clearer than the politicians' meaningless phrases and grasped straws of data.