Margaret McCartney: Technology isn’t enoughBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i620 (Published 01 February 2016) Cite this as: BMJ 2016;352:i620
All rapid responses
Re: Margaret McCartney: Technology isn’t enough . Wants are not needs. Politicans :Stop stoking expectation.
well said Dr McCartney and Prof John Fabre
I am not what you would regard a frequent correspondent. It seems to need an impending crisis before I write.
Nearly 20 years ago I wrote to the BMJ in response to an article which was sincere in intent but mistaken in cost and resource. BMJ 1996;312:1422. Re-visiting that letter today shows just how the wheel turns. We need true transformation.
There are several key themes that I feel need to be addressed.
• It is high time politicians stop directly managing the NHS. Ask yourself: Would we be better or worse off without politically driven expenditure into PFI, Darzi and NHS Treatment centres, walk in centres, NHS 111, and now the spreading of scarce resource for a 24/7 service?
The blog http://blogs.bmj.com/bmj/2016/01/26/john-fabre-the-total-absence-of-a-na... in this week's BMJ highlights many important issues and demonstrates that Jeremy Hunt , Secretary of State for Health controls the NHS and not the Board of NHS England.
The solution must be an independent Commission for the NHS & Social Care as called for by Former Health Minister the Rt Hon Norman Lamb MP and multiple other ex-ministers and organisations including NHS Survival (http://www.nhssurvival.org/)
• Technology must be intelligently tamed . Medical education at both under- and post-graduate has moved more and more to sub-specialism. Clinical skills and ability to deal with uncertainty are being replaced by fancy diagnostics and technology .
Health professionals and the public need training in living with risk. Old fashion, more holistic generalists are needed. Nurses and carers need training and empowerment in empathy and care not degrees in theory.
Systems need to support this approach. Anything other just adds to inflationary pressure.
• System diagnostics such as CQC, professional appraisal and revalidation are being wrongly used. They are more punitive than developmental. They focus blame onto individuals rather than the system. This reinforces the culture of fear that is rife in the NHS.
Why else do Chief Executives of Boards stay mute when their organisation is under pressure or failing? You have to be fearful when the average time of tenure is 2 years?
Why else was it necessary to have an independent review into creating an open and honest reporting culture in the NHS? (https://www.gov.uk/government/groups/whistleblowing-in-the-nhs-independe... ) Why hasn't this culture changed?
If you run any engine or system at maximum revs relentlessly it is going to break. The NHS has been working at relentless exhaustion level for several years. Instead of hounding individuals the QUANGOs and system machinery needs to intelligently feed into the roots of workforce planning, education and commissioning
• In my view it is highly probable that modern healthcare is unaffordable. See Spending on health and social care over the next 50 years. Why think long term? Author: John Appleby of Kings Fund. (http://www.kingsfund.org.uk/time-to-think-differently/publications/spend...) The predictions in here are bleak enough. Then factor in the inflationary pressures of the next generation of genetic healthcare. This paper hopes for the compression of illness into the last few years before death. 32 years of experience tells me we are accelerating away in the opposite direction. This again inflates costs. One projection in the paper already shows EU states will need to spend 25% of GDP within a generation. What will society allow to be cut?
I finish my eLetter with nearly the same sentence as 20 years ago. I believe that we must debate these areas now and act soon to protect the NHS.
Dr Jon Tuppen
Competing interests: No competing interests