How to misdirect whole generations of healthcare professionals.
My peers and I have been directly prevented from maximising our professional contribution to the nation by the internal market. Claims that benefits arose from it are highly suspect. Certainly some amongst us profited hugely, many were exploited, many scores of millions of professional man-hours were squandered in meetings and over paperwork, resources were diverted from patients to managerialist flummery, treatment was denied or delayed and the nature and purpose of healthcare was corrupted.
Healthcare, properly delivered, is not nor can it ever be a commercial undertaking - neither as a faux-market nor as a neoliberal free market phenomenon. Its sole purpose is, or should be, the delivery of optimal healthcare. When rationing is required, and it always will be, then that must be a wholly and explicitly political decision that is clearly set before the electorate at election time.
The mechanism by which commerce was stabbed into the body of healthcare has been as destructive as the faux-market itself. Commercial/industrial management techniques are anathema where the 'feed-stock' consists of billions of unique and constantly varying individuals with capricious minds, bodies and disorders, the 'product' consists of billions of unique entities - often never fully finished, the workforce itself is the major part of the 'process' and the outcomes are so diverse and protean as to defy categorisation.
Contrary to Dixon's opening sally, historically practitioners of all disciplines were answerable to the patients first. The advent of the purchaser provider split, fundholding, commissioning and all the associated witless fandangos has only achieved spectacular wastes of opportunities to help patients, money, time and professional lives. It has been an unequivocal disaster.
Reformation of the NHS has to be a continuous process. There is no final destination because the nature of the changes that will be encountered are not yet known. However, some basic premises can be essayed:
Patients first - always and everywhere.
Rent seekers and politicians to be statutorily banned from influencing healthcare policy.
Professionals of all disciplines to be permitted to optimise their clinical practice without non-clinical distractions.
Develop the habits of direct professional co-operation and autonomy.
24/7 professional assessment and advice available to all, everywhere, free of charge.
Limits to NHS coverage agreed - stop covering the costs of treating minor and self limiting problems inter alia, employ Pigouvian taxation to provide additional NHS funds and, eventually, to reduce demand.
Institute cost effective and very slim administration in place of costly and bloated 'management'.
Consider departmental/practice PBR such that continuous improvement is rewarded, rather than targets achieved. The measures to be broad and department specific - thus everyone shares the jeopardy, from cleaner to consultant.
Where diagnostic protocols are complex, rapidly changing or numerous, for example malignancy, dedicated secondary care facilities be established to which those with suspicious symptoms or signs can be referred same-day for immediate triage, investigation and onward referral to the relevant specialty.
...and so much more.
Patients cast into the maelstrom of the private sector are very vulnerable. Is the treatment being offered that which is optimal for them or simply that which the company is prepared to provide? How can a patient tell? Who is scrutinising what is going on?
'Savings' in healthcare are actually a measure of treatment denied and profits likewise.
Rapid Response:
How to misdirect whole generations of healthcare professionals.
My peers and I have been directly prevented from maximising our professional contribution to the nation by the internal market. Claims that benefits arose from it are highly suspect. Certainly some amongst us profited hugely, many were exploited, many scores of millions of professional man-hours were squandered in meetings and over paperwork, resources were diverted from patients to managerialist flummery, treatment was denied or delayed and the nature and purpose of healthcare was corrupted.
Healthcare, properly delivered, is not nor can it ever be a commercial undertaking - neither as a faux-market nor as a neoliberal free market phenomenon. Its sole purpose is, or should be, the delivery of optimal healthcare. When rationing is required, and it always will be, then that must be a wholly and explicitly political decision that is clearly set before the electorate at election time.
The mechanism by which commerce was stabbed into the body of healthcare has been as destructive as the faux-market itself. Commercial/industrial management techniques are anathema where the 'feed-stock' consists of billions of unique and constantly varying individuals with capricious minds, bodies and disorders, the 'product' consists of billions of unique entities - often never fully finished, the workforce itself is the major part of the 'process' and the outcomes are so diverse and protean as to defy categorisation.
Contrary to Dixon's opening sally, historically practitioners of all disciplines were answerable to the patients first. The advent of the purchaser provider split, fundholding, commissioning and all the associated witless fandangos has only achieved spectacular wastes of opportunities to help patients, money, time and professional lives. It has been an unequivocal disaster.
Reformation of the NHS has to be a continuous process. There is no final destination because the nature of the changes that will be encountered are not yet known. However, some basic premises can be essayed:
Patients first - always and everywhere.
Rent seekers and politicians to be statutorily banned from influencing healthcare policy.
Professionals of all disciplines to be permitted to optimise their clinical practice without non-clinical distractions.
Develop the habits of direct professional co-operation and autonomy.
24/7 professional assessment and advice available to all, everywhere, free of charge.
Limits to NHS coverage agreed - stop covering the costs of treating minor and self limiting problems inter alia, employ Pigouvian taxation to provide additional NHS funds and, eventually, to reduce demand.
Institute cost effective and very slim administration in place of costly and bloated 'management'.
Consider departmental/practice PBR such that continuous improvement is rewarded, rather than targets achieved. The measures to be broad and department specific - thus everyone shares the jeopardy, from cleaner to consultant.
Where diagnostic protocols are complex, rapidly changing or numerous, for example malignancy, dedicated secondary care facilities be established to which those with suspicious symptoms or signs can be referred same-day for immediate triage, investigation and onward referral to the relevant specialty.
...and so much more.
Patients cast into the maelstrom of the private sector are very vulnerable. Is the treatment being offered that which is optimal for them or simply that which the company is prepared to provide? How can a patient tell? Who is scrutinising what is going on?
'Savings' in healthcare are actually a measure of treatment denied and profits likewise.
Steve Ford
Competing interests: No competing interests