NHS “reform” in England: where is the public interest?BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2014 (Published 14 March 2012) Cite this as: BMJ 2012;344:e2014
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A health care system will fail if patients and the public accept substandard care without knowing any better, whether it is provided by a state controlled system or a free market. There will always be a conflict between maintaining high standards on the one hand and keeping taxes down or maximising private profit on the other. Managers will always have to focus on minimising costs.
Despite doctors wishing to do their best for patients, many will have to give in to pressure from employers. In order to maintain high professional standards in the face of state or commercial pressure to cut costs, we need to make sure that the patient is well-informed or at least easily able to get someone else to check what is being done for them. For example, this could be done by preparing a simple, transparent, written summary where each action is linked to a diagnosis and each diagnosis linked explicitly to its supporting findings [1, 2]. This will also help nurses and doctors to understand much more easily what their colleagues have been doing, improve continuity of care, make it easier to learn and cut costs.
Most GP computer systems and hospital discharge summaries could be modified to do this automatically. Instead of fretting, we should respond to the challenge of changing financial circumstances by demanding transparent systems that safeguard patients and standards of care, irrespective of the country's political idealogies.
1. Llewelyn H, Ang AH, Lewis K, Abdullah A. The Oxford Handbook of Clinical Diagnosis, 2nd edition. Oxford University Press, Oxford 2009
4. Llewelyn H. Understanding Medical Decisions. http://www.transparentdecisions.org.uk
Competing interests: No competing interests
Sadly we are seeing increasing evidence of rather puerile grandstanding behaviour by members of our profession. Most recently we have numbers of them signing a letter to a not very widely read newspaper, threatening to stand against MPs who support the Government's current health Bill. There is no doubt that this is a very bad Bill and needs to be opposed but perhaps we need also to reflect on where we are at the moment. It is clear to anyone who has an iota of consciousness that the current system of PCTs and acute Trusts have already grossly fragmented the NHS.Many will be familiar with endless hours spent generating policies and formularies which are just slightly different from those of the Trust next door. We are familiar with the farce of "commissioning" carried out largely by non-clinicians. We see other clinical decisions taken under pressure from managers with no clinical knowledge, both in hospitals and PCTs.We are aware of cases-see Private Eye almost every issue-of cases of grossly iniquitous treatment of doctors by managers and senior colleagues, leading to months or years of "investigations". Even where the doctor concerned is vindicated (usually) those responsible move serenely on, often to promotion. there seems to be no central oversight in these cases. We see that Trusts have acquiesced blindly to the EWTD, often at huge cost and clear damage to the continuity of patient care and the quality of clinical training. We see on the near horizon revalidation, ironically a system with no evident validity. It was brought in under pressure from lawyers, members of a profession whose self-regulation is hardly an example to anyone else. It is meant to "reassure the public" but no member of the public to whom I have mentioned it had a clue what it was about, and when told did not care. Anyone with minimal common sense can see that the tragedy and disaster of Shipman would not have been prevented by this process, indeed he would have been one of the Politburo-approved "responsible officers" in all likelihood. Finally, looking for feet to aim at we have the threat of "industrial action" over pensions. Generally then we have a profession jumping up and down having found almost all the stables empty. We do no not see it proposing where we should go from here. Just saying we need "more resources" literallly does not do the business. I have my own ideas but so have others I am sure, and this is already long enough!
Competing interests: No competing interests