Thursday, 29 January 2009

QOF and the insidious creep of graphs and managers into medical practice.

For most members of the general public seeing a GP has not changed much in the last 60 years. You make an appointment go along and hopefully are treated.

We at ND wish we could say the same of medicine in the NHS but every politician who has seen his GP knows that the system is crap (after all they designed it) and regularly change it based on their 5 minutes at the doctors without asking anyone in their constant attempts to make it worse.

We here in Northernshire wonder if any other doctors have noticed how NHS managers are using QOF (Quality and Outcomes Framework) to direct medical practice? Or could it be that we are silently moving towards centrally controlled and regulated health care that works in a similar way to former communist states?

One of the concepts of the new contract was that it should be a “high trust contract”. We know from surveys that doctors are generally regarded as the most trust worthy members of society but ND’s team do not think anyone has asked about NHS managers trust, or even ability, ratings.

In Northernshire we have noticed that managers have discovered that certain spreadsheet programs can draw graphs.

For those that have used computers since the 1960s this is nothing new. We used to write the software ourselves to solve a particular problem and print graphs off using Xs to create the lines on the graph.

However in the 21st century there are now ready written software packages that do the same job. For the thick that are NHS mangers this is a godsend because they think they can now identify fraud or deviation from Party Policy by looking at a picture, sorry graph. For every QOF indicator they now draw, or more likely employ consultants to draw for them (we jest not on this one), lots and lots of graphs. They then look at the pictures, don’t understand them and point to anything that looks different.

The local commissars then send enforcers out to try to understand why some practices are different. They have no idea about this as they cannot work out why people have different heights but height is not standardised as per QOF so they don’t have to worry about height - just their graphs.

The thickerazzi then have little words in peoples’ ears and tell them they should do something different or else there will be sanctions.

And so the thickerazzi managers massage their figures to come into line with everyone else’s. Thus they show to Party Central that they are good comrade commissar managers as their graphs are the same as everyone else’s and so the local Soviet’s tractor production is on target. All is then well in the world of the MHS (Management Health Service).

Good idea unless you are a patient with a disease who needs treatment in the NHS. This massaging of figures by morons will lead only to one thing. Increased political and management interference with patient treatment and care. Patients are individuals and are different not collections of figures drawn on a graph.

Given that NHS managers are in the bottom third of your school in terms of ability you can see what this will do to your medical care? GP thinks you need this treatment but manager decides otherwise. Your treatment is not in line with the graphs and graphs must not be out with the Party’s targets.

This is already happening. ND stumbled across members of the team being told by the local commissar manager for an important disease that now needs treating (having been ignored for years by the same manager) that the Practice did not have enough people with the disease and so they would not get paid unless they found a few more patients with the disease. So we know have to find or invent patients with this particular disease in order to meet a local Politburo target and then subject them to unnecessary intervention so that the idiot managers can tick a few more boxes. And draw graphs to show they have met targets.

So dear patients when you cannot access a particular treatment that your doctor thinks you should have please do not blame us. Our hands are well and truly tied by all the thick people in your class at school who never went to medical school. They probably struggled in their maths lessons to draw graphs but with the advent of computers they don’t have to. The graphs are even in colour and have lines that aren’t made up of Xs. Isn’t progress great?

Praise be to the Party and NHS managers for keeping communist working practices alive in the democracy that is the NHS. And for drawing graphs that are so essential for good patient care.

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