The Circle of Life.

For anyone who has worked in the NHS for longer than any reforming politician’s mayfly like lifetime involvement with the NHS you start to see what we at the ND Central term the “cycle of life” otherwise known as idiots effing up (sorry about the grunt word) the health service.

What is this?

It is where a politician decides that something that works does not work and therefore needs reform.

Therefore a politician reforms it (because they have power but not necessarily the ability or more importantly the knowledge) and creates subdivisions to manage the same problems more “efficiently”.

For example: we have an inefficient large local Health Authorities “unresponsive to local needs” and a “drain on resources” so we will create “more locally responsive” and “efficient and accountable” Primary Care Group(s) to “improve patient care”.

So in an area with one health authority you might get 2 (or more) Primary Care groups each of which needs its own and new Chief Executive, Secretary etc.

Result a growth in front line healthcare professionals called managers. Work is duplicated to achieve the same or less and no doubt “efficiency savings” result. Wages do not go down for individuals but the wage bill increases as you have 2 or more parallel organizations working side by side instead of one before. They do the same jobs albeit with new and often more important sounding titles.

This is not like opening a new hospital in an area where the extra beds and doctors and nurses employed could treat extra patients it is doing the same job as before but creating more managers to do so.

These don’t work so now the Politicians will now create more efficient “Primary Care Trusts”. In doing so we will re employ all the former Health Authority and Primary Care Group employees (as redundancy payments cost too much) and so save the Public millions by increasing management costs to do the same job as the original Health Authority but with more people than before.

This process seems to occur in 10-20 year, or 2-4 Parliament, cycles, costs millions, does not improve healthcare but does increase bureaucracy.

Another example is we shall abolish the district general hospitals (run by the former health authorities). We shall create NHS Trusts (lots of them) and after a few years merge them into the same hospital units that were the former district general hospitals but with new names e.g. NHS “Foundation” Trusts.

More managers, lots of work for printers, sign painters and web page designers all on the front line treating patients but bugger all improvement for patients as there is zero extra healthcare provided via reforms.

Praise be to the Party for supporting the Circle of Life or is it actually an ever widening spiral of increasing management with each change in Party? And so the cycle continues ever downwards, more inefficiency, less front line care and there is an election coming.

Joy unconfined.

We are off . . .

Well the worst kept secret in British politics was leaked over the Bank Holiday and confirmed earlier this week namely the date of the next General Election.

Now elections in the UK for those of us at the coalface of healthcare bring many reactions.

13 years ago a lot of doctors were sick of the Conservatives and thought that a change with a promise of decent funding for the NHS would be beneficial. Several medical bloggers, more longstanding than we, have stated this on their blogs over the years but all have realized this optimistic hope turned out to be a very false dawn.

Although percentage GDP spending on health has increased the average grunt on the ground as a GP is still is using a flintlock musket as opposed to a M16 to deliver health care today. Some of us a few decades ago saw better healthcare offered to patients then than we can now get locally and that was from watching Quincy ME.

The media are having a field day as they have a month to analyse every politician to pad out news and are already predicting a hung parliament (one where no one Party has a majority) and its dire consequences for us all and so are bigging up minor parties to pad out media minutes and column inches.

Those of us in healthcare who have been around for a while are just waiting. While we can exercise our democratic right to vote, it will not alter what whichever party gets it will do to the NHS.

History is said to be written by the victors and so is healthcare policy.

The picture above (click it to enlarge it) illustrates our thoughts on politics and the NHS. A once green and promising leaf of an idea called the NHS has been successively nibbled by the slugs, snails and caterpillars of successive political reforms over the years to produce a moth eaten leaf in tatters.

Each Party continues to eat away at the leaf, a different bit at a time, rather than to build on its strong bits to produce a useful, functioning NHS and discard the tattered bits which it leaves to fester sometimes indefinitely.

We are on a bit of a cynical roll here due to a huge influx of grunt humour the last few days so stick with us.

Healthcare in the UK appears to be a protected commodity (at present) for all of the Parties for they are all promising to protect the NHS with no cuts in funding. No cuts in funding is not the same as keeping pace with inflation.

The UK economy at present is not like a lifeboat sitting high in the water keeping all government departments dry and above the waterline.

It is a life boat full of holes though which debt is incoming with all of the parties desperately trying to bail debt out of the lifeboat to keep it above the waterline and avoid UK plc going under.

Within the lifeboat, on different seats, are the various departments including the NHS which is sitting close to a smaller hole than most other departments leaking debt at a slower rate so the bo’suns are all telling us.

No politician is plugging the holes and the lifeboat is still sinking.

One Party is saying that it will continue to pour in debt and the lifeboat will sink but if all hands in the boat are kept well fed then eventually they will pump the lifeboat dry despite the continuing influx of debt bringing it down.

Another Party is saying jettison the debt heavy bo’sun and this will stop us sinking and get a new lighter bo’sun who will make us all bail harder in the hope the boat rises a little quicker by reducing the influx of debt.

The Third way are the liberal democrats.

This is our reflection on current UK politics. As far as healthcare is concerned no way will be easy.

Deciding which way to vote is for an individual and it is their choice. Whichever way you choose to vote, like sailors in a leaking lifeboat, we will be bailing like hell in healthcare just to keep politicians afloat for some years to come let alone make any headway.

And while we bale the NHS lettuce leaf will get nibbled some more as well.

Praise be to the current Party for giving its patients their first real “choice” in years.

And what a choice it is especially in healthcare. More lettuce anyone?