Monday, 20 October 2008

Unethical, scandalous and downright dangerous

It always amazed me just how poor the national press are at picking up on the rank mismanagement of the health service by the various organisations that are so good at getting most things so very wrong. It's no surprise that the NHS is so badly organised because the management structure is virtually incomprehensible to even those that work within it, consequently no one is in charge and no one takes responsibility for anything; the structure is also subject to incessant politically motivated tinkering, so that even when people have become accustomed to one dysfunctional structure, it is changed to yet another.

Primary Care Trusts (PCTs) are great examples of this rank waste and routine incompetence. They began as small and actually reasonably functional organisations that worked closely with local clinicians, however what they have matured into would make even Frankenstein's mother ashamed. They are now huge bureaucratic disasters, frequently there are more PCT managers than local GPs, and the job titles that are on offer at the local PCT would shock even the mighty Kafka. For example the Oxfordshire PCT started as six people, it has now proliferated into a monster that employs more than 2,500 people.

You would think that a body that employs so many people and that controls so much tax payer's money would employ a few highly trained experts in public health, so that they could efficiently go about spending their money in evidence based manner. You would be wrong, the PCT is made up of numerous people who have very little understanding of medicine and certainly no qualifications in public health. Have a look at some of the useful 'world class commissioning' posts on offer here.

Sadly PCTs do not work alongside hospitals and clinicians to try to improve health care for patients, they expand their own monstrous bureaucracies because they can, while the money that funds their expansion has to be cut from other budgets that fund essential local services such as hospitals. Hence as the PCT proliferates, more and more short sighted managers are employed to run schemes that are set up to deliberately starve good local health care services of cash. This vicious cycle continues, PCTs expand as local services are cut, that's the good old NHS for you, power to the uneducated and minimally trained PCT manager, and this is power without any accountability or responsibility.

A cracking example of the PCTs continued drive to stop paying hospitals for work that needs to be done is demonstrated by this scheme that actually pays GPs not to refer patients to hospitals, I kid you not. Unsurprisingly this scheme has been slated by local clinicians and patient groups, so what did the PCT have to say on this, something convincing? hardly:

"We have got significantly increasing rates of referral into secondary care providers. We're not sure why, so we're trying to understand why."

So referral rates are going up, so rather than trying to work out why this is happening, the ingenious PCT managers have decided to encourage GPs to refer less, they don't seem to care that the vast majority of these referrals are likely to be clinically necessary, they just want to reduce referrals and don't care if patients die in the process. I also understand that the PCT is so poorly run that they don't actually know what the correct referral figures are, a little birdie told me that the PCT's figures are laughably inaccurate. So not only is the PCT threatening patient safety by ignoring the clinical need of patients, but their dodgy decision making is based on the most dubious of figures that are being interpreted by people with no detailed understanding of clinical medicine. Lunatics taking over the asylum I hear you say, personally I think that's a little harsh on the lunatics.


Deb Acle said...

You have distilled everything that I bang on about into one succinct post. Thank you.

I think we have the answer for all the mayhem in your fourth paragraph:

"Hence as the PCT proliferates, more and more short sighted managers are employed to run schemes that are set up to deliberately starve good local health care services of cash."

Having read reams of source documents from DOH/NHS et al, I can see that this cash starvation is deliberate. That these various mechanisms - PCT, NICE, etc - have been purposely set up for exactly this function.

The minimal training conspires with the limited foresight and limited intellects of NHS managers to create an environment where gvt's strategy is easily denied....these functionaries have no need to know the bigger picture, theirs is to do or die. Need to know and plausible deniability.

Meanwhile, they enjoy the fullest protection of gvt. The press - and certainly broadcast media - is almost entirely complicit. Jobbing Doctor hates the Daily Mail with some justification. But it is the one rag that consistently gives space to these horror tales (and, whether we like it or not, it is the voice of middle England).

jayann said...

Several trusts are doing this. (See the national media.) Yes it's scandalous.