Monday, 3 January 2011


For those of us in medicine who are really old there was an idea in the 1970s that oil would run out (by now?) and we would not have enough of anything and so we should recycle everything that was well recyclable. This is now called being environmentally friendly.

Not exactly a daft idea for if you realize that we live in a world of finite resources, are not proposing to go to any new worlds that space might potentially offer, and the population increases year on year without any increase in resources then you may have to make do and mend in order to keep humanity going.

The same applies to keeping the supertanker called NHS afloat and steaming somewhere useful although many working in it are seeing it rot from within as numerous “reforms” corrode away at its core idea(ls).

A few articles recently and some events local make us realize that the NHS is a recyclable body par excellence but not necessarily of items useful.

It does not recycle expensive healthcare products for one of the team recalls chucking away acres of rain forests when they worked in an anaesthetic department when in order to fill 50mls worth of syringes you probably filled a bin full of 500ml of paper, cardboard, plastic and glass.

NHS reforms recycle nothing but produce mountains of paper to be read that ultimately will land up in a landfill and have achieved what exactly? Anyone remember the paper not patients initiative a few years ago?

We think we got that one right(?) but how many practices have seen their stationary bills fall since the paperless Choose and Book system was introduced? How many hospitals have seen the same thing happen there?

Politicians do not recycle anything but merely reinvent the wheel. The current ConDem regime is no different. Politicians do not even listen to their own let alone those who elect them. Most GPs will listen to more political opinions in week than politicians will base their policies on as a result of listening to focus groups for years or their own busy once or twice a month “surgeries”.

One group of people have to listen to people to do their job the other pretends to listen to people but actually listen only to their cronies. People when they go and see a doctor or nurse want to get better. This means they need access to something called treatment.

When we as GPs talk to our patients they have a problem. If we can treat them we do so but some patients, for example someone with suspected appendicitis, cannot be treated in General Practice we need to refer them on to an appropriate specialist.

Our patients do not at the free of point of care NHS normally ask us how much commissioning has been involved in order to get their operation they just want treatment. This is in contrast to politicians of any Party who think that commissioning is what healthcare really is. They concentrate on the management of healthcare not its provision. The desire for treatment is not an irrational human ambition but the rational desire to get better. If you are ill you want treatment to get better not management.

Commissioning is nothing more than a bureaucracy or management structure created to deliver nothing other than more management. It does not deliver healthcare, for healthcare, amazingly enough, is delivered by healthcare workers not managers or politicians.

Commissioning is a failed policy that has been recycled by the ConDem coalition from the burnt out ashes of fundholding. These ashes were breathed on and reinvented by Za Nu Labour as commissioning, nay not just any commissioning, but “world-class” commissioning ®™, that was never fundholding, and is now recycled as GP led commissioning. Ain’t recycling great?

NHS management is also on the bandwagon of recycling as a lot of useless bureaucrats were (hopefully) going to lose their jobs. The medical press have been full of scare stories as to the fact that commissioning will not work as senior people are leaving in droves and we have noted this earlier. These senior people are the same ones who have not made it work so their loss is of dubious significance.

According to the medical press even those at the top are being recycled but unfortunately not into anything useful for the healthcare of Jo Patient.

The new NHS as per the White Paper allows clinicians the potential to redesign the NHS.

However it also denies them the ability to do so for already the so called abandoned targets are to be replaced by new “outcomes” all centrally dictated by the likes of NICE, the NHS Commissioning Board, Monitor and the Care Quality commission all of which are recycled versions of Za Nu Labour’s centrally controlled failed NHS.

Just as in any good Gulag you can do anything you want as long as the guards approve. The current perimeter fence of commissioning, aka healthcare provision to real patients by PCTs is being torn down and the inmates in some Gulags are running a few yards further beyond the fence but only as far as the next newly built and ever thickening bureaucratic fence. So freedom in the NHS Gulag is a nice word but a very limited concept in the new, “liberated” NHS.

Instead of recycling valuable resources that are in short supply on the planet in order to preserve their useful existence the politicians are taking that which has fed numerous mushroom farms and are planning to redeploy the same mushroom farm food under the direction of GPs.

If you are a turkey waiting for Christmas you would want to preserve your head as long as possible. So PCTs are doing the same. They are still in charge and locally are doing their damnedest to stop GPs doing anything useful. At the same time they are devising structures that mean that when PCTs do finally go the same idiots that are now running the show will still be running the show for they are not allowing GPs to do anything different.

Stop GPs doing anything useful now and when they are allowed power in a couple of years time they will have no choice but to preserve the status quo and the ancien regime.

And instead of the Department of Health there will be a new layer of (additional) management called the NHS Commissioning Board et al. In the current NHS management begets management but it rarely, if ever, creates or improves hands on healthcare merely hampers it.

Plus ca change plus c’est la meme chose it is said but we bet at the end things will be well so much more bureaucratic.

Just as someone once said the bomber will always get through so in the current world of (NHS) healthcare the manager will always get through and like the bomber what the manager delivers is merely destructive to those needing healthcare. And it keeps coming in waves and waves and destroys the crews of those in healthcare just like Bomber Command destroyed bombers and their crews for bombers are cheap and quick to produce.

Ultimately the Germans rebuilt and perhaps after another half century the NHS may do the same. Who will get the blame for failure if the new commissioning does not work? Not the bombers that are NHS managers but those that will be forced to take over the flying of these bombers from the managers - the GPs.

There will be more Dresdens than there will ever be Cologne cathedrals left standing but still the NHS will have done some more recycling.

Praise be to the Party for that which is to be recycled will be the flotsam and jetsam that has denied first world care to many while providing world class commissioning to most. Once again the wheel is being recycled, reinvented and lots of time and money will be spent to make sure it is less round than the last square one.

Commissioning failed in a time of relative plenty but is now being recycled in a time of famine. Only one group of people will lose from recycling and that is those that we are meant to serve. Our patients - but they will, once again, be better managed.


Anonymous said...

Re'commissioning is nothing more than a bureaucracy / management to deliver more management'. Spot on not to mention a nice, fat little earner in the (US)private sector for the snake oil salesmen that pass for politicians.
PS keep blogging

the a&e charge nurse said...

"management to deliver more management" - that's why NHS bureaucracy has more than doubled.

This sort of stuff doesn't come cheap?

the a&e charge nurse

nhsmadwife said...

Even if the GP'S do take over from the PCT'S, where the hell would they start! It's such a complete mess, I don't envy you.

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