Monday, 1 March 2010

Scams, wheezes and targets.

We love the phrase “socialized medicine” here at ND Central and the current Party’s thinking and management of healthcare takes many of us back to our childhood days and service days when there was a Cold War on.

We remember reading many articles in the more learned free world press about Five Year Plans, about how wheat production had exceeded all targets when people were starving and wheat was being imported on the quiet from the US and Canada and there were so many tractors being produced that no one could possible starve.

Like many other UK bloggers the comparison between the former Soviet Union and today’s NHS has been self evident. There are many issues we could compare and contrast but we will stick with targets.

Just think how many targets have been set by the current Party and how many have been failed to be met?

The first set of targets most GPs would have encountered was the so called Quality and Outcomes Framework known with "affection" as QOF.

QOF is neither Quality, as all the standards are sub optimal compared with most current medically accepted guidelines, or Outcomes but merely a system of coding devised in a huge fudge by the Department of Health and the British Medical Association who between them trashed out a deal called the new General Medical Services (nGMS) contract in 2004. It is dumbed down medicine to allow thick managers to measure “performance”.

We here at ND Central think this is rich as those now measuring “performance” were those in our schools who could only just count and write.

The DoH fully expected these targets to be too tough for some of the brightest individuals in UK society to meet and expected most GPs to only score 600-700 out of the original 1050 points available.

Unfortunately, in the (currently?) free world that is the NHS, targets may be met as initiative is (still?) allowed. Most GPs scored a 1000+ and Gordon Pasha at the Treasury was not happy and so hated GPs for achieving what he, as an intellectually and ocularly challenged Scot, if you believe Mr. Clarkson from Rotherham, felt was impossible.

The Party however does not like initiative and so shifted the goal posts and has done so year on year with the aim, comrade patient, of improving your health care experience. Sorry we meant to say pay GPs less and so salvage the economy wrecked by the idiot GPs not those nice bankers and politicians who pay their bonuses (and expenses) out of your taxes. Remember dear reader you will always be able to see a politician or your banker within in 48 hours we are sure it is a target?

And more importantly if GPs miss targets they don’t get paid but bankers, if they make a loss do , as do Government ministers when they miss their own targets. Clearly a level playing field here comrades.

This week we have had a few irate patients who are starting to get wise to the scams, wheezes and targets that are delaying their treatment. Do remember this is the most affluent part of Northernshire and some of our patients can read, write and a few even use their fingers to count up to ten so we will be leading the UK in this realization.

The first was a patient who had been referred to a consultant who had waited a long time and thought they must be getting to the top of the list but had to go away on business overseas for a few weeks. Their problem was not life threatening but was getting worse as time went on.

Now, being a good comrade patient, they thought that rather than the hospital send them an appointment that they would miss when they were abroad, they would ring the consultant’s secretary and ask if they could not send them an appointment then.

Well done comrade patient, such self sacrifice on your part will help all of us in the Great Patriotic War.

When the patient was finally sent for their appointment they realized they has been waiting 22 weeks, not 18 weeks and questioned this.

"Oh no, comrade, you have only waited 18 weeks for when you are away on business, or on holiday, time stands still and the 4 weeks you were working does not exist or count as part of your wait."

So much for being helpful. We now advise all our patients of this scam if they tell us they are going away. If you miss an appointment another will be sent. If you tell them you can’t go your wait is increased.

Remember, comrades, 4=0 not 4≠0 as you were taught at school. Time and mathematics redefined by the Party for your, and all good comrade patients’ benefit.

Another scam we encountered this week is the “we will make you an appointment and then cancel it” but with a new twist.

This is pretty common in the NHS whereby in order to meet the 18 week target you are sent an “appointment”. Target met.

Then you get a letter saying “due to unforeseen circumstances” or “due to medical staff leave” you appointment has been cancelled. Well you probably have believed these scams but when you get the same letter 3 times?

One of our patients had this experience and rang to rearrange an appointment that clashed with an important family event.

They rang to rearrange their appointment only to be told that the next appointment was 6 months later. The patient questioned this only to be told:

Oh no you can’t have that appointment it is outside the 18 week target and is the only one we have. You WILL HAVE TO GO back to your GP and ask them to refer you again so we can meet the targets”.

If this has happened the hospital would have been paid twice via Payment by Results as when the patient did not show the practice would have been billed. And then billed again when they were actually seen.

We wonder who is the loser under all of these Soviet style targets and scamming?

Just as the Soviet Union could not feed its own population during the Cold War and could not meet its own targets but always did, we now have in the UK a Department of Health and Ministers chucking out targets and not meeting them but scamming, lying and cheating in order to falsify figures.

Unfortunately only one person loses under this mountain of bureaucratic incompetence and that is the patient. The alleged “consumer” in the “internal market” that is there to serve (shaft?) them of their hard earned tax paid to Government.

Is the current internal “market" and targets, formerly known as the NHS, now merely a structure of healthcare of the managers, by the managers and for the managers (that) shall not perish from this earth?

Praise be to the Party whose many reforms and targets have made things so much better for patients.


Dr Grumble said...

If you miss an appointment another will be sent. If you tell them you can’t go your wait is increased.

It makes no difference in my part of Southernshire. If a patient fails to attend it is not our fault but it may mean we cannot meet the target so we cannot send another appointment.

The good thing about these targets, despite the mad element, is that until we had them the managers showed no concern whatsoever for the waiting lists. Now they realise what the doctors always knew which is that if you have a clinic on a Monday bank holidays can cause havoc. The work you would have done during the holiday has to be done later which is no holiday at all.

Northern Doc said...

We remember a time when doctors were concerned about waiting times and operated to reduce these waiting times for surgical outpatients.

They felt that anyone with a suspected cancer should have to wait no longer than 2 weeks to be seen in outpatients and then should be able to be admitted for surgery within days.

The doctors achieved their target and that was over 20 years ago in a centre of excellence. No choose and book, much less management and no internal market. Just a desire, combined with ability, to do things better for the patient.

A belief in what is right will out perform targets everytime.