Sunday, 22 April 2007

No evidence behind quacks - D'oH


Following yet more badgering via the Freedom of Information act, further light has been shed on the scanty evidence base upon which government reform is based.

It seems that everyone one turns these days there is some kind of untrained monkey being handed more responsibility while the service is being stripped of the properly trained professionals. It is happening in the health service with nurse practitioners, health care assistants, emergency care assistants and physicians assistants; while there classroom assistants and community support officers in other areas to name just two examples. It is not rocket science to point out that you generally get what you pay for to some degree, and that the never ending erosion of proper education and training cannot be good for services in the long term. I am already getting hot under the collar just thinking about it.

Anyway on the topic of physicians assistants it turns out the DoH has no decent evidence behind their introduction:

"Please see website www.aapa.org. Although the PA role is new to this country there is a growing number of testimonials from Consultants and General Practitioners who have worked with PAs. "

That is it. They can only refer me to the far from objective American Association of Physicians Assistants and point to anecdotal evidence that hasn't been documented. This is pathetic.

For those of you that don't already know Physicians Assistants are 'health care professionals' that are trained very quickly and cheaply to do certain jobs that doctors would normally do; the DoH claims that it's all ok because they are so clever that they instinctively know when they stray 'outside their area of competency', it's a shame that this chat is nothing more than class A tripe.

Don't forget that the government is spending millions on this reform when there is about to be a massive glut of unemployed junior doctors; the DoH tries to justify their own massive incompetence as regards workforce planning:

"You then ask if it is cost effective to have an excess of trained staff over the number of jobs available. Arguments can be made to support this view – equally, arguments can be made to suggest it is more cost effective to plan for slight under training. Workforce planning is not an exact science, especially for an organisation of over 1 million staff, many of whom take several years to train. It is likely that at any one time there will always be some temporary under training or over training."

I don't think the public would agree with this lame duck justification; given that junior doctors cost several hundred thousand pounds per head to train, this bit of DoH incompetence may end up costing several the tax payer several billion pounds.

This is not merely a matter of money either, there is the slight issue of 'patient safety' that the DoH loves to ramble on about. These under trained workers will inevitably make more errors and the patients will be the ones to suffer.

Another alarming feature of this dumbing down is that the under trained are often handed responsibilities that they are not even meant to have, take classroom assistants teaching classes unsupervised on a regular basis in a manner that is outside their defined job description; incidentally the same happens in hospitals with health care assistants as they are frequently handed work that only nurses should be doing.

While the DoH and the CMO Sir Liam Donaldson waffle on about 'patient safety' and an 'open' culture in which mistakes can be learnt from, it is rather apparent that they are knowingly leading the health system down a very dangerous dumbing down path that is propped up by a culture of nontransparent authoritarian leadership. This culture of top down fear driven management comes from our beloved politicians and the very same DoH; just one example of this is brilliantly documented here as regards the dangers of whistle blowing in the Stalinist NHS. This recent attempt by certain MPs to exempt themselves from the Freedom of Information act is pretty symptomatic of the continued erosion of key democratic pillars by our politicians.

Unfortunately I believe that this lack of openness, honesty and transparency is evident in in many other areas of government policy, not just health. The difference with health is that people will die directly as a result of this baseless reform agenda.

I would challenge anyone reading this blog who doesn't believe that dumbing down kills patients to try to chat to a doctor about it, unfortunately a vast majority of us have already seen real examples with our own eyes.

1 comment:

The Scribe said...

Well, I completely agree with what is said here.

The other problem with moving skills onto "other staff" is deskilling our juniors. I know thats the problem with junior shrinks anyway.

I would quite like some figures from the government as to the error rate and numbers of patient deaths following these changes. Ahh but statistics are a big no no for the government aren't they. I often wonder how many wards do not monitor their death rates. Of course, no statistics no accountability. Thats interesting isn't it?

There is no such thing as transparency in the Department of Health. Its a bit like a huge onion - so many layers of concealment.

Dr Rita Pal