Tuesday, 29 September 2009

Monkeys for management, the NHS rot

As we all know money is in short supply, the government has frittered away billions on brainless ideological schemes in many policy areas, this is especially relevant to health and the NHS. Who can forget the billions that have gone on management restructuring every two years (SHAs/PCTs), PFI schemes of appalling value, C&B/PBC (the market), Darzification and Darzi's privatisation of general practice et cetera.

The lack of understanding of medicine and health care in general is excellently shown by this chunk the article in the Telegraph:

"Sixty per cent of activity which now takes place in A&E departments should happen in community clinics within five years, the document says, along with 55 per cent of outpatient treatment. Thirty per cent of outpatient appointments will be stopped altogether. Managers say not all appointments are necessary, though many doctors argue it is impossible to know in advance which patients do not need to be seen. The number of diagnostic tests carried out will be cut by 15 per cent, while the amount of surgery will be reduced by seven per cent."

This statement exhibits a rank lack of intelligence and a rank lack of understanding of medicine. Shifting work out to lame little community clinics does not work, not only do the under trained staff at these units have no idea what they're doing but they often end up referring most stuff onto other services anyway, they do not have enough knowledge and skill to actually properly sort patients out.

Just because nothing is done at an out patient appointment it does not make this appointment unnecessary, a lot of appointments involve patients being reassured and adequately diagnosed by a specialist. Not all flood defenses are necessary, does this mean that those manage our flood defenses will go about deciding which ones to remove before the next floods hit us? Of course not, this is the logic of morons. With medicine becoming every more sub specialised it is inevitable that referrals will increase as it becomes harder and harder for generalists to adequately manage in subspecialities which are becoming ever more complex with new treatments becoming available of which they know very little. In modern medicine patients are also becoming more empowered and knowledgeable, this will also drive up referrals to specialist services.

The idea of reducing diagnostic tests and surgery in this context is also completely nonsensical. In the modern day drives to cut diagnostic tests will probably lead to more litigation and hence increase costs, while as medicine becomes more complex and subspecialised, it is inevitable that diagnostic tests and surgery will need to increase. As imaging develops we are constantly finding new indications for surgery which are proven to be effective, you simply cannot aim to reduce diagnostic tests and surgery in this context, it is utter lunacy.

The layers of bureaucracy are now proliferating. Various uneducated ignorami at the DoH, SHAs and PCTs are wasting a massive amount of money in trying to increase efficiency with stupid policies that try to directly reduce referrals in a top down manner. This is done by creating more administration to regulate clinicians in an Orwellian manner, telling clinicians not to refer is plain stupid, clinicians do not refer for fun, they refer when they think the patient will benefit from a referral, so top down interventions to reduce referrals are actually in conflict with good medical practice, it encourages bad and arguably dangerous medicine.

So millions and billions are now being wasted on various crack pot schemes that aim to save money by effectively stop proper medicine being done. In this way money is wasted enforcing bad practice and bullying clinicians. This is a blatantly Stalinist system at work, it is a disgrace. Many of us have now seen first hand examples of this kind of logic at work in the workplace, PCTs are now refusing to pay for certain hospital services that patients need, the demand doesn't just go away if you refuse to pay for something, fiddling the hospital out of money doesn't make certain ailments disappear.

The current system sees various bureaucracies fighting each other, there is no cooperation which would result in efficiency savings, PCTs are fighting hospitals for money, the DH is clawing back money from PCTs, and then finally the government will cut the money off at the source. In the meantime patients will not magically get better, their illness will not just go away. Fiddling the books helps no one in the long term.

The government and our administrators would do better to look reality in the face, in an NHS in which administration costs have almost tripled in a few years thanks to their endless tinkering they would do better to stop the rot, stop the top down artificial market, get rid of the PFI deals, stop wasting money on management consultants that tell them to sack clinicians and hire more management consultants, stop the reforms that are increasing the waste and inefficiency. Start thinking about the needs of patients, start trying to meet their needs as best you can and stop hiring more administrators to increase the efficiency of the system, this is akin to pouring petrol onto a fire in order to put it out.


Anonymous said...

totally agree - scrap the QOF etc

Anonymous said...

Hear hear, the QOF system requires lots of administrative monkeys to administer and the benefits to patients are questionable.

Anonymous said...

Not likely to happen, a lot of people make a good living out of the nhs. Expanding management has helped a lot of people who would never make it in the private sector and as they are the decision makers it is unlikely they will cull themselves.

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