Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Cost of protest
- Jayaprakash Ayillath Gosalakkal (23 September 2006)
-
Where Are The Medical Voices Raised in Protest: Fit For The Future?
- Mark Signy, Lui G Forni, Richard M Venn (25 September 2006)
-
medical voices
- alex macleod (25 September 2006)
-
Failure of the medical voice
- Rod Storring (27 September 2006)
-
Lost voice of the medical profession
- peter j mahaffey (2 November 2006)
|
|
|||
|
Jayaprakash Ayillath Gosalakkal, Consultant Paediatric neurologist University hospitals of Leicester LE1 5WW
Send response to journal:
|
One of the reasons why protests gradually die down is because of the realization that it may be futile and harmful for your future prospects. The medical hierarchy has as many powers of patronage as the political hierarchy and are not loath to use them. They are also entrenched and often deprive those who raise issues of quality from membership in interview panels, discretionary points, and budgets to improve their departments. Many would feel it is not worth the trouble to damage your prospects for career enhancement by standing up for what is right and those who talk about merit, quality and clinical autonomy are considered quixotic. I feel that there should be constant replenishments of the entrenched medical hierarchy so that fresh ideas can blossom. Many have been in positions longer than the prime minister and, as one chairman in the USA memorably said, "You have the freedom of speech but I have the freedom to fire". Competing interests: Supporter of clinical autonomy and pure merit in the NHS |
|||
|
|
|||
|
Mark Signy, Consultant Cardiologist Worthing General Hospital, West Sussex, BN11 2DH, Lui G Forni, Richard M Venn
Send response to journal:
|
Where Are The Medical Voices Raised in Protest: Fit For The Future? Dr Greener asks whether the medical profession approves of the government's reforms and wonders whether the long history of medical resistance to health policy is gone for good. As he points out, proposed changes in the provision of healthcare throughout the country are providing the source of much debate. Principal among these is the proposed role of the district general hospital within the secondary healthcare system with the onus appearing to be a downgrading or closure of many such hospitals. This implies that either there is capacity within local hospital networks to absorb the current work or that primary care is both willing and able to provide extended services to prevent the need for much of secondary care. This is said to be both effective and achievable and in line with ‘modern changes in healthcare’. We are consultants involved in acute medicine in West Sussex a part of the Kent, Surrey and Sussex Strategic Health Authority which has attracted considerable interest of late regarding the possible restructuring of services. Not least among these are dramatic proposals in the reduction of workload from primary care, which we are assured are supported by colleagues in primary care. In order to assess the genuine views of our primary care colleagues a simple survey was conducted to gauge the degree to which our colleagues felt that proposed changes could actually be instigated. 130 questionnaires were sent to all general practitioners registered in the Arun, Adur and Worthing district addressing both emergency and elective medical care. 86 replies were returned (66%) of which 2 were not completed and one practice of 6 partners felt that they could not comment. This left a sample size of 78 general practitioners (60%). Based on proposals which had been made by the previous primary care trust (now of course restructured…) the following were asked. 1) Did our colleagues feel that a 20% reduction in emergency workload at the acute hospital (as proposed) was achievable without compromising clinical care in emergency general medicine, clinical haematology, cardiology, medical oncology, neurology, rheumatology and geriatric medicine?. Less than 10% felt that a 20% reduction was achievable and approaching 75% felt that no reductions at all were possible. The results are shown in figure 1 together with percentage reductions thought feasible.
Figure 1:Percentage of GP respondents who felt that each percentage reduction in emergency workload was possible 2) We asked if a 30% reduction (as proposed) in outpatient workload was achievable in the specialities mentioned plus gastroenterology, dermatology, respiratory medicine and nephrology. Again 85% of the GP sample thought the proposals unrealistic within the current system. Interestingly, only 15% of GP’s felt that a 30% reduction in dermatology outpatient referrals were possible despite this being an oft targeted area nationally (Figure 2).
Figure 2: Percentage of GP respondents who felt that each percentage reduction in outpatient workload was possible 3) We asked if the proposed 8% reduction in ICU admissions was believed to be possible: not a single GP responding felt that this was achievable. 4) Finally we asked whether the suggested 57% reduction in A&E admissions was believed to be possible. Only one GP of the sample of 78 thought this feasible. This was a simple study to gauge the feelings of our local primary care practitioners towards the proposed changes which appear to being instituted as a matter of faith without any evidence base. Clearly there is little confidence in the proposals among the GPs who will have to manage the referrals under the proposals. No doubt significant investment may make some of these targets achievable but at what cost? Not only would this require financial outlay but would also be to the detriment of locally provided secondary care. If the proposals were instituted a minority of patients would perhaps be better served with regard to ‘care’ being closer to home. The majority however would face longer journeys to larger secondary care centres and in emergency situations this could prove unsafe. As Dr Greener says, the government has found ways to interfere in medical practice on a remarkable scale. Our results show that proposed reductions in secondary care are deemed impossible without unprecedented change detrimental to all. We thank our colleagues in West Sussex for taking the time to answer our questions. Lui G Forni Consultant Intensivist & Physician (lui.forni@wash.nhs.uk) Mark Signy Consultant Cardiologist (mark.signy@wash.nhs.uk) Richard M Venn Consultant Intensivist & Anaesthetist (richard.venn@wash.nhs.uk) Worthing General Hospital, Lyndhurst Road, Worthing, West Sussex BN11 2DH. Competing interests: We work in the National Health service and wish to preserve its integrity. Competing interests: None declared |
|||
|
|
|||
|
alex macleod, consultant ophthalmologist Royal Hants County Hospital, Winchester SO22 5DG
Send response to journal:
|
‘Where are the medical voices raised in protest?’ asks Greener, in his article about the onslaught of NHS reforms. Protest to whom? Hospital managers are desperate, ministers are not interested. Medical voices are easily characterised by the media as self-interested. More importantly, public awareness of the true direction of the reforms has been limited. However, when departments or hospitals close, and tax-funded services transfer to for-profit organisations, then protest at last is likely to be heard, from doctors -and patients. It is premature to conclude that the profession has acquiesced to the blitz that is descending on Bevan’s NHS. Competing interests: None declared |
|||
|
|
|||
|
Rod Storring, 42 Felstead Rd London E112QJ
Send response to journal:
|
Comparing notes with medics at international conferences has been deeply depressing for many years. Despite all the new cash it continues to be so. Knowing what treatment is available in other countries, and then not letting the British Public know what treatment they should have, and thereby forcing the government to do the right thing, makes us as doctors responsible for the poor state of the NHS. Opinion polls always demonstrate that doctors are trusted ahead of politicians and journalists and the public could therefore be appealed to directly. Unfortunately the medical profession is too hierarchial and the leadership is too often far from the business of looking after patients as well as being too vulnerable to persuasion of many varieties. Competing interests: None declared |
|||
|
|
|||
|
peter j mahaffey, consultant surgeon bedford hospital
Send response to journal:
|
Greener asks the devastatingly obvious question as to why there is a lack of real protest by the medical profession against what is being done to the NHS by the present government. Thank God he asks it, because it seems no-one has done so before, or at least effectively. Of course there are paradoxes to his query, because in the same breath as asking where the protest is, Greener also mentions "the opinions expressed by the doctors I speak to every week". So what he really means is 'effective protest'. British doctors everywhere, in every walk of medical life, realise that such profound damage is being done to the NHS as we know it that there will be little recognisable left within 5 years and indeed it will probably have imploded like a dying star.But they are not speaking out. Why? For a start they remain cowed by the way the Bristol, Ledward, Alder Hey and Shipman affairs, all to do with renegade individuals no more numerous than one might find in any group of over 100,000 individuals (be it politicians, journalists or even ministers of religion) have been very effectively stage managed to create the image of a tarnished profession. This was a true gift from God for a government intent on weakening the only potential opposition to their plans. Secondly, doctors are embarrassed by the massive pay-rises accorded them by recent contract negotiations. Consultants, especially, never wanted their new contract. All they wanted was recognition that they worked a lot more for the NHS than the government said they did. Government did not recognise this and said "We'll put you on a contract which counts your hours". In fact it might be said that this was the first manifestation of its obsession with numbers and targets rather than quality. The consultants responded by calling their bluff and saying "OK, if you dont believe us, then lets have a contract and you can put your money where your mouth is". Surprise, surprise, the government has now, to its horror, realised that the consultants were right, as every single job plan has been agreed with managers. They have scored a massive financial own-goal and are squirming to find a way out. If the government wanted to salvage even one tiny lesson from this contract debacle, it would be that the only group who REALLY know what is going on at the coal-face of the NHS are the doctors. But this doesn't really explain why doctors are not shouting from the roof-tops about the sack of the NHS. There is a bigger picture. Despite their fondness for money and a comfortable life, doctors are pretty socialistic creatures. They have a Robin Hood like philosophy which usually put their patients interests ahead of everything else because its the right thing to do. Even ahead of their families. Or at least that WAS the principle. When I entered medicine in the 1970's, the institution came first in one's life, ahead of all personal things. One worked until the job was done and snatched family life in the remaining hours. One had the ethos of wanting to do the best for that institution, whether it was the family practice or the hospital department. And therefore the best for the patient. But around the 1980's there came a veritable explosion in medical technical advances.....heart and kidney transplants, CT and MRI scanners, new cancer drugs, microsurgery, new cardiac drugs and so on. Whilst 'doing the best' for one's patient remained the ideal and indeed was allowed during the following 15 'golden' years, suddenly the treatments prescribed by doctors became a real threat to the economics, indeed the survival, of many Western governments or health insurers.These governments realised that they had to curb doctors' spending, but they couldn't do it openly because they knew that doctors always wanted what was best for their patients and therefore to curb them would be an open expression of reduction in medical quality. This is when they started to investigate other more oblique, and opaque ways of cutting expenditure on medical treatment. In Britain the process started under the Tories when their hard man, Kenneth Clark, introduced the White Paper reforms of the early 1990s where under the guise of putting doctors in control of spending (something they were never intrerested in and always devolved to managers) he introduced departmental budgets in hospitals and Fund-holding in general practice. This was a Governmental masterstroke along the lines of 'divide your enemy and rule them' because doctors within the same hospital suddenly vied with each other for budgets and for the work which brought in the money, and GP practices suddenly found themselves powerful enough to bully hospitals over income. This was the start of the break-up of professional coherence in the UK. At the same time, for reasons more difficult to understand, Britain as a medical leading nation was losing its world position. London as a medical mecca for patients seeking the very best treatment went onto a very steep slope of decline from which it has only now reached the zenith point where not only have we lost all this business, but every single one of our own Premiership footballers who needs his knees operated on now goes abroad. Simultaneously we lost almost every single visiting doctor from the old Commonwealth who came here to learn his/her trade in medicine. Now WE go abroad for OUR experience as trainees. Therafter, during the 1990's and the past 6 years of the 21st century the screw has turned ever more painfullly with one political reform of the NHS after another. Virtually every one of these has attacked the ability of doctors to carry out the best treatments unfettered by policital considerations. Recently 'targets' have blatantly addressed quantity over quality, patients are moved openly or clandestinely to the private sector (which secretly most specialists despise), referrals are now made to hospitals rather than individual doctors ( which effectively nullifies the natural demand of patients to flock to the best) and once again the community finances all hospiatl activity with crippling pressures on the GPs who refer (or rather are encouraged not to), and on the hospitals who receive (or rather should). So why, one may ask, is all this silencing doctors to the measures they see government taking which are producing such irreversible damage to our NHS? Because all this has happened so fast, within effectively a single generation of the profession,that the victims are shell-shocked. They have had their breath taken away, their ambitions to do 'the best' badly dented. They understand that whilst its easy to put the savings represented by firing half the secretaries and outsourcing their typing to India on the balance sheet, it will never be easy to express the results of a badly done hernia operation in the same way. They have been forced to swallow their instincts and almost to connive with the Govt at budget medicine for all. But can they sleep easily with this? Yes, because they are so well paid now, and its so important not to rock the institutional boat to gain one's new in-house merit award, that life is easier if one just plays the ghastly game and leaves the hospital on the dot of 5pm (as per one's new contract) and goes back to the family one had previously neglected and who are willing blindly to forgive past absences and rejoice that 'Daddy will be able to take us to Scouts, or Daddy will be here for the football game on Saturday morning'. Basically, the activities of this Government, far more than any other, have successfully shot the medical profession's previous pride and resistance to pieces. It is no longer interested in fighting. Why should it be. The Government has allowed more of the rich to get richer, encouraged the purchase of honours, intimidated those who don't do its beck and call, and rewarded mediocrity. It is simply not fashionable to be a professional in modern new-labour Britain. And there's a final issue....leadership. Just as the entire Western world seems unable to find statesmen as leaders, so at a national level its just not in vogue to 'lead' from the front. Whilst the British Medical Association presumes to be the leader for all UK medics, yet so little is it in tune with the thinking of its members that only 3 years ago the contracts which it had so painfully negotiated for consultants and GPs were rejected. And where, on the basis that most doctors will admit that the NHS is on the edge of irreversible destruction, has been its clarion voice? Amongst the Academic institutions, the Royal College of Surgeons came very close indeed to getting into bed with the Government in return for relatively trivial sums for a new surgical unit, until it recently gained one of the few Royal College presidents prepared to speak out. And so when there are no leaders, there is no common voice. And so I fear that Greener's informers are correct ...... the will for resistance is gone, and the power is gone. All in the space of less than 2 decades. Competing interests: None declared |
|||
