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NEWS: Zosia Kmietowicz Doctors blame untested policies for financial crisis in the NHS BMJ 2006; 333: 9 [Full text]

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The BMA's flight from reality

stephen black   (4 July 2006)

Evidence-based managment consultancy

Alan A Woodall   (5 July 2006)

The BMA's flight from reality 4 July 2006
stephen black, management consultant london sw1w 9sr Send response to journal: Re: The BMA's flight from reality	Is the BMA positioning itself like an old-fashioned trade union: out to protect its members from any sort of change regardless of the impact on the public? This is often the implication of the rhetoric at the BMA annual meeting. Here are some examples of where the rhetoric is disconnected from reality. One speaker moans about the huge sums spent on IT. Another that nurses have to spend more time scurrying around to find free beds instead of caring for patients. Neither sees the irony of the fact that the way to avoid the latter problem is to spend more on the former. Computers are good at keeping track of patients and free beds, but the BMA would prefer the money spent on "front-line" staff. The result being that hospitals are like a hotel where, to find a free room, you have to knock on every door and check for guests. In fact the NHS spends a great deal less on computers than almost any other organisation and wastes a great deal of staff time and energy as a result. But actually fixing problems is not what the rhetoric is about is it? Another speaker complains that the internal market makes it impossible for trusts to control their costs. This one I just don't get. The market doesn't affect trusts' costs: they are an internal problem for trusts and they have the same control over them as they have always had. The market affects their income and patient flow. The impact of that is that trusts can no longer compensate for poor control of costs and inefficiency by doing cushy deals with commissioners or being bailed out by SHAs. That means that trusts might actually have to get a grip on their costs. A true union can't tolerate this sort of interference with its members rights. We can't go around admitting that some doctors and some hospitals are more efficient that others, can we? Competing interests: Managment consultant working in health
Evidence-based managment consultancy 5 July 2006
Alan A Woodall, GP trainee/SpR Public Health Shrewsbury and Telford Hosptal NHS Trust Send response to journal: Re: Evidence-based managment consultancy	In response to Mr Black, there is no evidence that the (re)introduction of the internal market (as Practice-Based Commissioning and Payment By Results, in place of fundholding) will lead to significant improvements in population health. Comparison of UK and USA population health indicators show, in virtually all cases, that the market-driven US health system fails to deliver across the whole population compared with the UK. We can do better, but moving towards privatisation is not the direction we should take. Indeed, there are major concerns that the introduction of market principles such as practice-based commissioning and redirection of finances into the associated administration will serve only to worsen health inequalities for the most deprived populations. The replication of US style health systems in the UK, delivered by giants like United Health Europe and Kaiser Permanente, will not provide quality care for those with the least ability to exercise 'choice' - the poorest in our society. Most patients do not want to 'choose and book' from a plurality of competing providers miles away from their homes - they want good, locally delivered health care that is accessible and equitable. The NHS is currently undergoing yet another demoralising service reorganisation, led in the main by a vanguard of external management consultants and private providers who stand to pick at the choicest meat from a dying NHS carcass abandoned to profit seekers. The NHS spent over £1 billion on 'advisors' who seem to have a tenuous grasp of the clinical realities of delivering high quality services across populations with widely differing health needs. While clinical staff are increasingly required, quite correctly, to base their clinical and public health interventions on solid research evidence, there appears to be no equivalent requirement for management consulting interventions to be evidence-based. The introduction of untested management theories is mainly to provide political capital to be seen to be 'doing something' and to dismantle covertly for profit an NHS/social care system which is already highly efficient compared to other health care models. When the vultures have finally flown away, bellies full, what a pathetic skeleton service will remain for the most disadvantaged people in the UK. It is time to depoliticise the NHS, and to prevent politicians and businesses solely interested in the profit margin from abandoning the health needs of the poor. Competing interests: Doctor working in the NHS who is is a supporter of 'Keep The NHS Public'