Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Rumours and Potential Libel
- Jay Ilangaratne (20 June 2003)
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THE NHS WORKS: but only at some levels
- Graeme M Mackenzie, CA28 7RG (21 June 2003)
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Time for a medical minister of Health?
- Ian H kunkler, Crewe Road, Edinburgh, EH4 2XU (22 June 2003)
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Milburn's Double Standards
- aidan gleeson (25 June 2003)
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MILBURN'S RAPID DEPARTURE
- Stephen Squires (27 June 2003)
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Different in Wales
- Marcus J Longley (28 June 2003)
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Jay Ilangaratne, Founder Medical-Journals.com
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Based on "Rumours" the Editor suggests sexual and financial scandal as possible undisclosed reasons for the resignation of Alan Milburn.In the interest of fairnes to all(including Mr Milburn) would the Editor kindly divulge the source/s of the allged "Rumours".Or could it be a BMA/BMJ-spun rumour to develop a provocative and potentially libellous piece?No doubt,the Editor will try to justify the need to propogate rumours,and defend its implications on the BMA & BMJ. Competing interests: Litigation against the BMA & Dr Richard Smith;a recent Judgment of the EAT can be seen at: www.employmentappeals.gov.uk/uploads/EAT1025012432003/index.htm |
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Graeme M Mackenzie, GP Whitehaven, CA28 7RG
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This short editorial is significant. My feeling is that the NHS does not need a leader. The NHS works at many levels. My feeling as a jobbing GP is that my 17 years as a primary care foot soldier has been spent by and large in an effective part of the NHS. We are available, have devloped on many fronts (IT, premises, changing clinical policy to name a few examples)and I think are excellent value for money. The interface between GP and elective secondary care does not work. I have seen a significant deterioration in the service I get from secondary care. The delays are infuriating and the cause of most stress in GPs and patients. It may be my failing but there is an increasing sense of two parts of the NHS at war. The secondary care sector seem at times intent on annoying GPs with a reluctance to admit emergencies and the out patients are increasingly dumping on GPs. Casually through discharge letters they slip in work for us to do or worse still add in possible diagnsoses and expect us to follow them up. "Dictaphone differential diagnosis" I call it. Something is wrong with the system when a GP feels so aggrieved. Why is this? Are they overworked? Is the whole culture wrong and encourages them to hold GPs in contempt? Are we the scapegoats? Are we scapegoating them? The upper and middle tiers of the NHS seem to me to be almost irrelevant. In my practice I see an effective organisation which responds quickly to change and manages relvantly on a daily basis. An interesting example is the new near patient INR testing. When I saw this I thought "whow!". We basically set up a new service within a week and paid the whole cost. I did contact the PCT but I have now lost faith in the NHS admin to organise the finance to get this sort of thing off the ground quickly. This will only get worse and we will increasingly subsidise the NHS (and the bosses will be relieved all the way to the bank). However there is no alternative. IT has been a huge leap forward in primary care. We have led the way and have fantastic records. Now all I see is the NHS threatening to dismantle it all with a centralised system (which will not work of course, becuase IT "hobby" GPs know the size above which systems fail and it is probably above practice level). They do this with contempt for the amazing work GPs have put into IT and almost point blank refuse to defer to the IT leaders of the NHS:the GPs. Incredible!!! Having said that the NHS e mail system was inspired if only secondary care would come on baord we could transform the efficiency of the NHS. No breath holding here! I am a peculiar mix at the moment. I think NHS primary care on many levels is great. But I am increasingly cynical about anything else really working that well. The politics, empire builders and single issue groups seem to scupper most developments. In many ways the NHS needs dismantled so that large strategic interfering polcies are not required or created. Better relationships at the right level may then follow. The NHS probably does not need a leader because inevitably he will try to lead and fail miserably! Competing interests: None declared |
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Ian H kunkler, Consultant in Clinical Oncology Western General Hospital,, Crewe Road, Edinburgh, EH4 2XU
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Editor - you rightly identify that there is no universally acknowledged leader of the NHS. There are pointers which suggest that medical leadership in the NHS can effect improvements in services which years of centralised control from the Department of Health and a succession of ministers has failed to achieve. Perhaps the best example has been the appointment of a national cancer director in England and his equivalent in Scotland with designated budgets for cancer services. From a position before 2000 where cancer services showed wide variations in quality, the development of multiprofessional collaboratives in England and the managed clinical networks in Scotland have been key in improving the patient’ s cancer journey. While there remain huge challenges ahead (of which the increasing costs of cancer care, training sufficient cancer professionals and an IT system are but three), real progress has been made. Reducing the waiting time to diagnosis and surgical treatment for breast cancer is one example. The design and delivery of high quality cancer services requires an intimate understanding of cancer epidemiology, diagnosis and treatment as well as education and manpower planning. In a rapidly moving specialty such as oncology, any lay Minister necessarily depends on expert medical advice. He or she does not have the knowledge to manage the service directly. In oncology where developments in molecular diagnosis may revolutionise approaches to therapy, a medical perspective is essential to making sensible decisions on organisation of services and investment. Perhaps the Prime Minister should consider appointing a clinician as the next Minister of Health.There are recent precedents in Italy and Egypt. He or she might oversee a board of national medical directors in each area of health care supported by the permanent secretary in the Department of Health. With an adequate budget the improvements in cancer services might be replicated in other areas of the NHS and the current impasse in the consultant contract amicably resolved. References: Smith R. Changing the “leadership” of the NHS. BMJ 2003; 325:1340. Competing interests: None declared |
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aidan gleeson, Consultant in Emergency Medicine Beaumont Hospital, Dublin
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Now that Alan Milburn is out of health and enjoying a stress free existence, maybe he will look more objectively at his government's policy of trying to force consultants to change their contract of employment. Isn't it just ironic that he, the man who in recent years has been uncompromising in his drive to make consultants work longer hours and do shifts in the evenings and at weekends, has resigned because he feels he is working too hard and wants to spend time with his family?! Competing interests: None declared |
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Stephen Squires, Retired Scientific author/journalist EX20 4QF
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Alan Milburn's sudden departure, in my view, is likely to have been prompted by the revelation that he has been party to a £10 Billion fraud of frail, sick and vulnerable elderly people by forcing them, in cahoots with social services departments, to pay for care costs which the Appeal Court ruled in 'Coughlan' must be met in full by the NHS. Upon the intervention of the Health Ombudsman, patients or their estates, are now being reimbursed and Social Services are having to reclaim from the NHS Council Taxpayers funds which they unlawfully applied to supporting means tested patients who were the sole responsibility of the NHS - amounting to some £25 Billion. And still NHS trusts and social services departments continue to defy the Appeal Court by applying totally unlawful 'Eligibility Criteria' in order to compel elderly patients to pay for care services which are theirs free by right. Obviously Milburn would not wish to be in the vicinity when this load of excrement hits the fan! Further information is available on www.nhscare.info Competing interests: None declared |
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Marcus J Longley, Associate Director and Senior Fellow Welsh Institute for Health and Social Care, University of Glamorgan
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The personification of leadership is interesting. If the test you propose is right - how many doctors know the 'leader'? - I suspect it may be a little different in Wales. Jane Hutt, the Welsh Minister, has the advantage that she has held the post for 4 years. But size may also come in to it - Wales is smaller, and therefore easier to know and feel you know the leader; and Ms Hutt only has to travel 7 miles home to see her family! But knowing whose name is on the door is not really the issue. Leadership must also be about the ability to lead - to inspire (or at least persuade) sufficient people to act in a corrdinated way to achieve some worthwhile objective, and to make sure that no-one derails the process. Here, again, size matters - devolution of power and initiative is essential to making such a lumbering beast move in a coordinated way. Wales has that smaller scale, but arguably has gone too far in creating 22 Local Health Boards for 3 million people. So we need a visible, credible leader, brave enough to let go, but able to ensure that strategic coherence is not threatened. Competing interests: None declared |
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