Thursday, 25 June 2009

Choice gets better in “World Class Northernshire”

ND being a grunt periodically patrols the perimeters of our Practice and talks to fellow grunts and asks how things are going (or hanging). An essential part of maintaining a lean mean fighting machine is identifying weak points in contrast to top down PCT managers which are the major weak point in UK healthcare getting better as they never engage the enemy called illness and never talk to patients or staff. Hence they are all wise (and therefore powerful) as they know not for they see not or hear not.

Today we spoke to our two loyal secretaries who were trying to do their best for one of our patients but were being countered by the “World Class” idiots in a “World Class Commissioning PCT” which boasts that it offers “Choice”. (Not).

The words world class and choice have meaning elsewhere in the world as per the Oxford English Dictionary but in the NHS they are meaningless sound bites which are mutually exclusive and equate to crap health care anywhere else in the world other than on planet NHS. Planet NHS is currently like Moon Base Alpha in the 1970s Space 1999 TV series moving uncontrollably out of any solar system known as rational and good healthcare due to years of huge uncontrollable gravitational forces mismanaging it called politicians and NHS Managers.

Enough of our childhoods for now. Those of you who remember David Hasselhoff, and his part in the fall of the Berlin wall, may know what we are talking about how a once great “Party” gave its people “choice”. The wall came down and these people who were detained behind it now have choice as opposed to “choice” which is that now offered to NHS patients by the current Soviet style NHS management structure.

This is the problem our secretaries encounter when true patient choice is controlled by the Party’s NHS “choice”.

Our secretaries’ problem was that they wanted to do the best for a patient as do we as doctors. Our patient is currently working with an increasingly worsening shoulder problem that if, they can see the right surgeon can be cured, and so return them to being an economically productive person at work and also, as a minor side effect, give them better health. Surely an ideal in a National “Health” Service? One would hope and think so.

The patient had seen their GP who knew what the medical problem was and what the correct treatment was and had discussed NHS “choice” and said Mr X can fix this for you but you need to go to hospital Y which you allegedly can do because you have NHS “choice”.

You see now that we are really good little comrades here at ND Central honest. In fact we offered choice before there was ZaNu Labour “choice” since at least the 70s. But we digress.

The patient has a problem with their arm that might be fixed by an upper arm joint replacement or corrective surgery it is so severe. They can’t lift their arm and so cannot work.

Simple problem you might think, use “Choose” and Book to find a local upper limb surgeon and send the patient to see the local upper arm joint replacement specialist.

Our secretaries tried seeking real choice to look for the locally respected upper arm specialist surgeon suggested by their GP and can find that this local specialist only does hip or knee problems on the “Choose” and Book NHS computer system where “Choice” is determined by local idiots working for the local Thickerazzi.

The specialist is a well qualified and very experienced orthopaedic surgeon whom we know can deal with most orthopaedic problems especially upper limb problems.

So our secretaries refer our patient to see this named consultant and book the patient into a “hip” or “knee” clinic the only ones available for this consultant on the “Choose” and Book computer system knowing that the patient will see the same consultant as these clinics are all that is offered for this expert consultant under the “Choice” agenda even thought the consultant’s main interest is upper limb work.

The referral is rejected because the local Politburo managers want the money to go locally to the local idiot hip surgeon who thinks he can operate on a shoulder but only if you want your feet facing in opposite directions after your shoulder surgery.

The idiot managers also see the word “shoulder” which is a much bigger word than “hip” or “knee” (more than one syllable in fact) and so they don’t understand why the word “shoul” is not the same as “hip” (or knee) and so the referral must be wrong. Instant rejection.

This is acceptable if you are a “World Class Commissioner” but not if you are a patient who would after surgery like to go back to work able to use his shoulder again rather than split his pants every time he takes a step after his shoulder surgery at the local Tractor plant.

Praise be to the Party. Less and less choice with each day that passes as the increased use of “Choose” and Book is used by the idiot managers to manage costs and waiting lists not patients.

How can we correctly treat patients when there is no choice?

The only way we can access this surgeon is to send a paper referral to his secretary or the patient pays to see him privately and then transfers to his upper limb NHS list.

We are not allowed to send paper referrals as these are intercepted by the local referral management center and the patient cannot afford to go private.

Looks like the return of the dead letter drop for referrals will be coming soon to Northernshire. Where are our Harry Palmer specs we feel a return to Berlin is coming . . . ?


Prisoner of Hope said...

In case you've not come across the term (or definition) before here is a summary of "Skilled Incompetence" which your posting so eloquently describes:

Many top executives pride themselves on their skill in avoiding and managing conflict. However, when managers neither speak candidly nor put important facts on the table, candor is lost, communication suffers and so does the company. Skilled incompetence is a condition in which people excell at doing what they shouldn't because it seems right. These managers are "skilled" because they act without thinking. They are "incompetent" because their skill produces unintended results.

Source: Harvard Business Review Sept 1st 1986 - Author: Chris Argyris.

In fact the "unintended results" are often so bad that they achieve the exact opposite of what was intended.

GrumpyRN said...

Oh dear God!!! What happened to see a GP, who refers you to the surgeon they think is most appropriate to treat your problem, said surgeon sees you in clinic and operates or not as he thinks fit?

Sorry! had a flashback there to pre 1990's must be getting old.