Sunday, 18 August 2013

Tales from the Darkside 004: Marshall DC’s pennies in the collection box for A&Es.

The recent news about the UK’s prime minister’s generous £ 500 million (over 2 years) to be spent to ease the A&E crisis (= not met politically generated target) is really a drop in the ocean according to our Newbie Comm GPs. If you do the maffs then £ 250 million a year spent equally over Englandshire’s 212 CCGs equates to a Jeramiah bonus of about £ 1.18 million per CCG. However the Party has announced that this money will be targeted on the worse performing A&Es some 50-60 we believe which equates if 50 is used as £ 5 million a year.

This is no different to the UK’s state education system where if you perform well you do not get extra to perform better instead the Party thinks that if you do badly giving more money will make you do better.

NHS managers are at best in the bottom third of the UK’s state education system and they like to keep things very simple. So rather than attempt to see a problem in a broader context which involves an alien process to most of them called thinking they instead focus on simple things called targets.
Targets are black and white to an elite cohort who left schools with minimal qualifications and suddenly realized they had to work to survive. With minimal qualifications they answered the NHS needs you ads in droves. Hence NHS Staffordshire. Targets good, patients bad. 

So for years NHS managers have persued targets and ignored patients for they get treated for free and one of their targets is the A&E 4 hour wait. No NHS manager will ever have had to prioritize in the way that the GPs we report on have had to in their previous lives. 

They will not have had to say which comes first like a child not breathing and a cardiac arrest in the next door cubicle. 3 members of staff available who do we treat first and where do we deploy? Major car crash 6 severely injuried victims, 5 dead and sudden appearance of a ruptured aortic annerysm at 01.00 and 20 sore throats and drunks who could not see their GPs until tomorrow hence urgent attendance at A&E to be seen in 4 hours. 5 nurses and 2 doctors to cover. Only the 4 hour wait target is important here to managers for all of the above must be seen within 4 hours or else. Medical care is an optional extra as are appropriate staffing levels.

The NHS manager concentrate on the “target” that all of the above have to be seen within 4 hours. Now some of the above can wait and will eventually be treated and come to absolutely no harm in doing so. Working out which is the difficult bit.

So if you are not aware of this many PCTs have pumped millions and we are talking millions into meeting the A&E target with little return if any. Marshall DC thinks that chucking cash at a non problem is the solution while he, and his secretary of state for health Khunta “no clue about medicine”, ignore what has gone before if either of them actually knew.

If any fellow journos at any of the medical magazines the doctors we report on read want to do a FOI request for how much money PCTs have squandered over the past few years on their local A&E departments to meet a target we suspect that the amount of money on offer now to the few will pale into insignificance compared with the amounts that have been wasted by all PCTs in years gone by. You might also want to ask if other departments have received similar extra amounts over the years.

If we assume for the sake of argument that local Soviets have all applied £ 5 million a year to “solve” their local A&E “crisis” you can see that based on these figures at least £ 1.06 billion a year has been squandered each year over the past few years to address a target and will contune to be spent as well as Dave’s little extra. This is not spent on patient care this is spent (wasted) on target care.

The cause of the problem is political not medical and you can pump money in ad infinitum. The non paying patients will not care they will just keep coming for there is no comeback.

The NHS is finite the politicians’ and patients’ demands are infinite. £ 500 million/£ 108 billion = 0.0046% increase in total health spending. 

Praise be to the Party for once again pissing in the wind and ignoring the gale they created and wondering why they keep getting their feet wet.

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