More QraP - care pathways.

All three political parties in the UK regard the National Health Service (NHS) not as a service to patients but as a political toy that they can use as the Roman emperors used bread and circuses to placate the populus whom all politicians despise as did their Roman predecessors.

Your average Secretary of State for Health uses the NHS more like they do a toilet. They sit on it, crap on it and then move on to something else leaving all those who work in the NHS covered in smelly brown stuff that we then have to spend years sorting out while they disappear after a huge unproductive dump.

One of the things that strikes us repeatedly at ND Central is when children in often very deprived parts of the world are interviewed and asked what they would want to be it is usually a doctor, a nurse or a teacher all of whom should be professionals and by and large are trusted by most people apart from politicians who fear them. This is the perception in the third world where access to such professionals is less than it is in the UK and where professionals still have a degree of respect even if you cannot access them as freely as you can here both in terms of cost and distance.

Historically this fear of the professions has been so in any political persuasion from the far left (Pol Pot, Mao et al) to the far right (Hitler) and our current politicians are no different.

One of the most sinister manifestations of the theory of creep proposed by the medical blogger the Witch Doctor is we believe is that of the care pathway. What a care pathway is a mystery to those of us who actually treat patients but here are a few possible definitions here, or here or try here. We lost the will to live when we read the word tool for while we will happily here at ND Central to use a hammer as a real world tool anything branded a care pathway is merely a tool.

The care pathway is the creep of socialized medicine using the principal that all doctors are crap and the only people who can really treat patients are those who could only get into a medical school as a corpse to be dissected namely politicians and NHS administrators. This is why if you read the QraP indicators, Quality and Productivity comrades, you will see indicators Qrap 8 and Qrap 11 aka “Delivery of improvement along the care pathways.”

Over the last few months, and perhaps it is because it is autumn when nature starts to deposit and then digest all the detritus we have had increasing piles of detritus called care pathways for our consideration. Most are full of what might be best described as bovine excrement with frequent references to NICE manure and alternative manure treatments but packed full of the absence of any scientifically proven treatments.

What NHS care pathway would empower the professional to do to help the patient in the following instances?

NHS Care Pathway Apollo 13: Land on Moon and return to earth.
NHS Care pathway British Airways Flight 38: land on runway with all engines working normally
NHS Care pathway US Airway Flight 1549: take off do not hit any birds do not pass go and land as normal.

The answer is none of them for life is never as straight forward as a written diktat and sometimes deviation from the protocol is for the better as in all three of the above examples.

Fortunately in some areas of life a few professionals are allowed to make their own judgement but not in the new increasingly Sovietized NHS. Deviate from the Care Pathway comrade and even though you may save a spacecraft or land an airplane and all of its passengers safely you will fall foul of the Stasi and although you may save a life you may as a result not get paid for missing a quick Qrap.

Indeed every care pathway has been about restricting and denying care rather than allowing or improving access to care or the quality of care provided.

This is very worrying. For it is another nail in professional freedom for the Party are telling us what not to do now in order not to treat patients via Qrap. For there is now a target to reduce care see our last post and now insidiously via the Qrap above to reduce care further. So can you see where Qrap is going – reduce asthma care and then if asthma related admissions go up - introduce a new “care pathway” to reduce asthma admissions. Is this now the emergence of a Tripartite intergrated care pathway?

Deny NHS care via QOF micromanagement and allow the emergence of a better any willing provider?

What is worse is the fact that these so called pathways are determined by those doctors who believe that treating patients is best done in a meeting rather than in the consulting room. By avoiding patients this makes them better able to determine care for they will see not first hand the results of their mistakes, their little Qraps on their colleagues, for they are so busy castigating those who actually treat the patients to maintain the quality of care that they do not provide at all. Some may even be well hard once a week men.

Now for simple grunts in the field care of real pathways that patients can actually use involves such things as the application of a bit of Agent Orange to suppress weeds, a bit of gravel and tarmac here and there to ensure a smooth passage to the surgery or to repair a garden path in your average GPs baronial mansion’s garden not about the restriction of care via the local Soviet and its retards. Looking after paths is one thing looking after patients is a much bigger ball game.

When quack medicine, unproven treatments, and where and to whom you can refer for excellent treatment are denied by care pathways enforced upon GPs by the Thickerazzi of the average NHS committee does it not feel that the Eastern Bloc is back and back for good?

Praise be to the Party for progressive freedom in the form of ever restricted choice and centralized control.

We like bottom up reorganization of the health service it works so well as Orwell predicted many years ago. There may even be some new non top down, non targets called outcomes coming our way today – all 60 of them - whoppee!