Monday, 19 July 2010

Liberating the NHS: some thoughts on the Great Patriotic White Paper 002 of 007.

Well comrade healthcare workers on the frontline, the executive summary must have stirred you up in to a fever pitch of liberating zeal. You will no doubt by now be burning your local PCT and looking forward to section 1 “Liberating the NHS”.

We would urge you to have a stiff few vodkas for although the first battle in the liberation of the NHS is a mere 28 paragraphs it is word heavy and a long battle.

Gosh it starts so well as do all patriotic wars of Liberation with the following words of inspiration to those on the frontline (don’t forget your bingo cards as you read):

It is our privilege to be custodians of the NHS, its values and principles. We believe that the NHS is an integral part of a Big Society, reflecting the social solidarity (no reference there to Polish liberation comrade?) of shared access to collective healthcare, and a shared responsibility to use resources effectively to deliver better health.”

Phew the bingo card is red hot after that one short paragraph and it gets better!

“We are committed to an NHS that is available to all, free at the point of use and based on need, not the ability to pay.”

We think this means don’t cancel your BUPA subscription yet.

The usual empty words of increasing health spending, fairness, doing what is right etc follow. The new quango, the “NHS Commissioning Board" will have “an explicit duty to address inequalities in outcomes”. Whoopy we can’t wait to see how little this will mean but how big the salaries of those working for it will be.

Furthermore “we will uphold the NHS Constitution” and, “By 2012 will publish the first statement of how well organisations are living by its letter and spirit.”

Anyone know what is in the NHS Constitution? We know of it but it is an irrelevance to our jobs in the same way as the Geneva Convention is to those in Quantanamo Bay.

Current statutory arrangements allow the Secretary of State a large amount of discretion to micromanage the NHS.” Clearly “large” and “huge” are not the same words when applied to buggering up the NHS.

“We will legislate to establish more autonomous NHS institutions . . .” more quangos anyone?

Read on to the section “The NHS today”.

Super buzz words follow here: “At its best, the NHS is world-class. The people who work in the NHS are among the most talented in the world, and some of the most dedicated public servants in the country.”

Yes it is, and they are, and if you have had the privilege of working in genuine first world medical centres the benefits of their abilities are self evident.

Unfortunately most of the current swamp of NHS managerial incompetents do not ask how high can we jump but, how low as an intellectual slug can I crawl, to meet my targets and get paid and have done so for the last 13 years and called everything “world-class”.

It maybe “world-class”, but, and this is an almighty but, it is not first world class. If you think the NHS is world-class you are probably an NHS manager who thinks that wiping your bum once a week and having a dip in a sheep dip every other Christmas is “world-class” hygiene and that you can defeat MRSA by a wash your hands campaign.

“Other countries seek to learn from our comprehensive system of general practice, and its role as the medical home for patients, providing continuity of care and coordination.”

Since when? Most countries seek to avoid the costs and since when has “continuity of care and coordination” (hint Darzi centres, walk in centers, NHS Direct) been the home of any Government policy? Care on the cheap is the bottom line and in an economic down turn . . .

The NHS has an increasingly strong focus on evidence-based medicine supported by internationally respected clinical researches with funding from the National Institue for Health Research, and the National Institute for Health and Clinical Excellence (NICE).” Really?

Anyone playing a game of intelligent medicine Top Trumps knows that whoever quotes NICE has already lost the argument. Try it an international conference and reduce your audience to uncontrolled laughter. “Evidence-based medicine” is not cutting edge science it is a fudge often used by Government to justify crap care.

Other countries in the world admire NHS delivery of immunisation programmes.” Look at the map to see how good we are or again here.

And “Our patient participation levels in cancer research are the highest in the world?

An achievement? Or perhaps because the cancer care provided means that the survival rates and treatment provided are amongst the worst in the civilised world?

Ever been a patient who has been mismanaged and then had people falling over themselves to offer you a chance to take part in a trial? Dead if you do most certainly dead if you don’t. No Win Britain, like the World Cup, we take part but unfortunately the patients lose as the Managers try repeated new training techniques for the players sorry, patients.

There is nothing better than “take a chance” card in the NHS cancer care monopoly game. If you live in Mayfair you are more likely to win than down the Old Kent Road even in a National Health Service.

Now we are getting serious. “Compared to other countries, however, the NHS has achieved relatively poor outcomes in some (most?) areas.”

The Party leads on to some well hackneyed healthcare beasts to frighten Johnny Public like MRSA, and DVTs and even asthma but fails to comment on the causes of these diseases.

The “NHS also scores relatively poorly on being responsive to the patients it serves”. Never? Does that mean it fails to listen to its non paying customers?

The NHS is admired for the equity in access to healthcare it achieves; but not for the consistency of excellence to which we aspire. Our intention is to secure excellence as well as equity.”

One is cheap the other usually costs. Someone once said of healthcare you can have universal coverage, excellent care and cheap costs but you can only realistically have 2 out of 3 not all 3.Which do you think will win?

But onto “Our vision for the NHS”.

All in a little grey box. Lots of lovely words all about NHS la la land which few, if any, who work on the front line will recognise but all would like to provide. Anyone who thinks that is how the NHS works in the real world should seek immediate help from a mental healthcare worker as it should be laminated it and using it as a tool to screen for severe mental illness. Paragraph 1.10 if you are desperate.

Anyone who thinks this “vision” is real and works in the NHS at any level is mad or is a politician.

Back to black and white as it then says “This is our vision.” A dream or delusion? Read and decide for yourselves especially if you live and work in the NHS.

Our strategy to implement this vision draws inspiration from the coalition principles of freedom, fairness and responsibility.”

More piggies anyone? Freedom, fairness and responsibility?

We’d keep paying the BUPA subscriptions for when you are ill Freedom, Fairness and Responsibility will all be top trumped every time by NHS “efficiency gains”.

Now at last we get on to some bona fide military tactics. Stand easy soldier but listen up for:

The headquarters of the NHS will not be the in the Department of Health or in the new NHS Commissioning Board but instead, power will be given to the front-line clinicians and patients.

The headquarters will be in the consulting room and the clinic.”

Excellent! Our consulting rooms will now be like little Abrams tanks where we as the GP, the tank commander, can direct our crew to fire our patients at any target we like with no rules of engagement?

The Battle of the Economic Bulge won in the consulting rooms of NHS General Practitioners?

“The current architecture of the health system has developed piecemeal, involves duplication, and is unwieldy.”

Why is this so despite every Government since its inception “reforming it for the better”? Surely it should be running smoother than any Formula One car ever has?

“Liberating the NHS, and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”

Can we think of any recent liberations where troop numbers are reduced after the war is won? Equals more management but this time not central Government ones so that is OK.

Next we are onto “Improving public health and reforming social care”.

“Liberating the NHS will fundamentally change the role of the Department. Its NHS role will be much reduced and more strategic. It will focus on improving public health, tackling health inequalities and reforming adult social care”.

Nothing new there it will continue “strategically” reforming the NHS for the better, comrade healthcare workers in the same way it has for the last few decades.

“The forthcoming Health Bill will support the creation of a new Public Health Service . . .” Not another quango?

“PCT responsibilities for local health improvement will transfer to local authorities”.

Which ones given no PCTs or SHAs will our local councils take over? Or another layer of, sounds boring, quangos? Could a theme be emerging? Abolish one, make two . . .

“The Department will establish a commission on the funding of long-term care andsupport, to report within a year.”

Oh no not another one?

“The Government will bring together the conclusions of the Law Commission and the Commission on funding of long-term care, along with our vision, into a White Paper in 2011, with a view to introducing legislation in the second session of this Parliament toestablish a sustainable legal and financial framework for adult social care.”

Another one?

Another section starts with the title “The financial position”.

A simple summary of this is there is no money good luck.

And so at long last we arrive at the end of the first great battle of liberating our NHS the conclusion: “Implementing our NHS vision.”

Read our selection from this:

“This White Paper is our strategy for the NHS during this Parliamentary term, so that it is liberated to deliver the best quality care over the longer-term. In the next five years, the coalition Government will not produce another long-term plan for the NHS.”

Just going to have major re tinkering with this one every few months?

And finally dear comrade reader anyone who is a professional knows that the buck ultimately stops with you, in contrast to current NHS managements where failure means promotion so look at what the new Anglo-Soviet war on liberation ends with (altered annotation = ours):

“Once they are in place, it will not just be the responsibility of government, but of every commissioner, every healthcare provider and every GP practice to ensure thattaxpayers' money is used to achieve the best possible outcomes for patients.”

Praise be to the Party for so clearly setting out who will be at fault if the Great Patriotic War of Liberation fails. The infantry on the ground of course how could it be the Marshals in charge’s fault?

NHS Reform: if it ain’t broke, keep fixing it until it is.

Can't wait for the next installment can you?

No comments: