The market, university education and the NHS.

This week it was announced on one of the evening news bulletins that most universities will be charging the maximum allowed by the Party for university tuition fees of £ 9,000 per year. According to the figures in this piece 75% of universities will be charging the maximum.


This is interesting as one minister said that the higher figure would only be charged in “exceptional circumstances”. Another one thought that about £ 7,000 would be the norm with maybe only the Oxbridge universities would be the exceptions.

It is always nice to see politicians come unstuck with their policies and certainly there was outrage in a bit of southern Northernshire when shortly after Oxbridge announced they would be charging the maximum for a mediocre education a former polytechnic now promoted to a university announced that it too would be charging the maximum for something far superior.

This is not too dissimilar to what is going on in the health service which is being reformed by the same politicians who have overseen the university fee changes. They too have set a maximum fee for medical treatment but in this case there is less leeway for there is only one price so patients will not have to haggle over cost for healthcare will be “free”.

Instead the only “market” choice in healthcare for the “consumer”, an alien word to those us that still treat patients, will be the place of treatment and its quality.

Now if the price is the same, as it will be for most universities and healthcare providers, then the “choice” of place of learning/healthcare might be a factor in “consumer” choice.

For most people who want a serious education you would want the best university for your chosen subject or child so Oxbridge would probably be high on ones wish list certainly way above a former Northernshire polytechnic. This will not always be the case (in education) for some universities/polytechnics provide very specialised specific courses which others do not.

Now admission to a given university is usually via an admission procedure and based on academic criteria and interview and of course will not be based on ability to pay. You can apply to any university as long as you can afford the tuition fees and to live.

You will not be able to “apply” to a hospital in the same way that you as an individual would apply to a university but in both cases the cost of your “care” has been fixed by the Party.

So if “choice” of location is going to be consortia decided, overseen by the NHS Commissioning Board et al, and the price is fixed then the only real thing the NHS customer is going to get to choose via NHS “Choice” is “quality”.

So if say you do a history degree at Oxbridge for £ 9,000 will the quality of the education/healthcare provider you get there be the same as a history degree at a former Northernshire polytechnic/healthcare provider that also charges almost £ 9,000?

In other words will the fixing of price in education/healthcare lead to similar outcomes between say Oxbridge and the former Northenshire polytechnic? If it was your child who was going to have to find the £ 9,000 per year of fees as an investment where would you rather they get their education?

Ask now the same of your healthcare.

If the price is fixed, your NHS “Choice” consortia limited and your only choice is “quality” then where do you get the best healthcare and can you, or will you, be able to do so?

The market has worked well in education with the consumer paying more so will a similar fixed price market improve access, quality and drive down costs as per education?

Given that prices for education and healthcare are fixed then if education and healthcare are meant to make a profit how can a fixed price market generate a profit whilst maintaining quality?

Something will have to give. Price (fixed), location (fixed) and quality (variable).

Can you guess what will change for the better?

Praise be to the Party for pushing on with reforms whilst listening. It seems that in education the market has not listened to the politicians. Will it do the same in healthcare?

After all education has become “more” available and “affordable” to more people as a result of these reforms, hasn’t it?

Educationalists, inspections and computers.

There are a lot of thick people in medical education who think that the way “forward” is by using the computer. We at ND Central recently have had a load of educational and local Soviet “inspections” and the recommendations of these have all been along these same lines namely that:

"You are doing everything right and everything that you are doing needs “to be put online” to meet “quality” standards."

Does that mean tick one of our boxes?

This is a classic example of ill informed administrators, both educationalist and local Soviet ones, dumbing down to the point of blind incompetence, and even greater, ignorance.

We take issue with this complete load of bull for the following reasons:

1) If you are doing things right you are doing them right.

2) If you have the information and it is available then it is there.

3) If an educationalist is sufficiently anally challenged that all they can see is up their dark ar*e for information that is their problem, not ours. We can read and see points 1 and 2. (Think about it).

4) Ticking boxes is not the same as treating patients.

5) Those of us on the front line do not take a memory stick from our patients and plug it into our computers to get the diagnosis.

6) The presence of protocols, audits and e-portfolios on our desktop are of no relevance to our treating of patients. If the truth be told the time taken to find, load and read a resuscitation protocol will kill a patient. If you need to read an electronic protocol you haven’t been trained or are an educationalist and should not be treating patients period.

7) GPs do not have access to a huge amount of electronically stored data that (may be) useful when they are consulting but can still do their jobs despite of this “apparent” newly discovered “shortcoming”.

8) Anything online is hackable, and therefore is both compromisible and corruptible. We still have a duty of confidentiality, and of care, as GPs.

9) How does putting information on a computer improve medical care? Do we talk and look at our patients or spend our time clicking on protocols instead?

If a doctor/nurse sees and ignores anything on a computer it is there but maybe useless. If a doctor/nurse sees and ignores anything on patient it is there but maybe useless. Which is more important?

That which is on the patient, the alleged centre of healthcare professionals’ activities, is surely more important that which is on the screen?

Basic training to high standards, not loads of crap on computers, is the key to quality patient care. You can take quality training anywhere, computers are less portable than medical staff and their acquired knowledge.

It is the acquisition and application of medical knowledge that is the skill needed to deliver high quality medical care not the alleged “quality issue” of protocols being on a computer that (allegedly) “represents quality care”. An unread file on a computer may be there but if not used it may as well be in the Mekong delta of NHS computer clarity.

Treating patients in the field, for example at a roadside crash, a remote farmhouse with no piped water or oxygen, only what you have in the boot of a car or in a remote valley with limited, or no mobile phone and internet coverage and no phone lines is not the same as your average GP educationalist trying to demonstrate their complete lack of electronic skill when their memory stick does not work for a lecture given to medical students.

One such doctor is a waste of space, the other such doctor might be able to do things useful albeit at the handicap of no protocols loaded onto a PC to read while they treat a patient in the field. One is providing hands on care the other is a . . . ?

And finally most of the educationalist twats insisting on these changes are so old and backward they went to Universities whose medical schools did not have computers for them as students to use. Some of them will have gone through the whole of their training with no undergraduate teaching on MRI and CT scanning.

Some of us did not have this handicap that current educationalists have for we know that the computer is a tool. Most GP educationists have more computing power on their desks, or their barely used iPhones, than the astronauts in Apollo 11 had in their spacecraft.

What separates the astronauts from UK GP educationalists is the ability to use what is available on the ground as a tool. Storing information is not the same as using it or processing it. One is a clerical task the other requires thought and ability.

Medicine used to be a process that required thought but increasingly has become a clerical task via the “protocol” and the ignoramus’ tick box called QOF whereby “populations” = group of individuals rather than “individuals” = patients are treated. Hence the corporate drive to tick boxes to demonstrate “quality”.

Should we not be removing all of the pre electronic garbage from UK medicine as it is clearly substandard as they trained without the benefit of any electronic storage of data that all new doctors have to deal with?

Medical students, F2s and registrars hate e-portfolios and we at ND Central hate duplication of crap for no gain whatsoever other than a box ticked.

Praise be to the Party of all things electronic and how what used to be a simple process called education has been turned into an electronic nightmare.

Are the doctors now produced electronically any better than those produced using paper records? And are those who insist on electronic records for training actually fit for purpose for they have no e-portfolioes but insist that juniors should have them?

The hypocrisy of ignorance stinks and generates loads of useless work for those forced to use them for no useful purpose.

Education, Education, Education unless you can’t afford the co-payment

ND is still a grunt. ND has worked his way up through the ranks and is proud that ND has done so. ND is now in the privileged position of being able to teach medical students and junior doctors at various stages of their training. ND enjoys this as it is a rewarding two way process. ND teaches them and they teach ND in the new ways of medicine.

Over the many years ND has seen many students from many different backgrounds from many different nationalities and all have been bright and enthusiastic. ND did not come from a privileged background and managed through hard work and ingenuity to break even at the end of medical school. Statistically ND should not have got where ND did. ND relates to the students who say that “I am the first of my family to get to University” or “I am from a working class family”.

One of the biggest complaints from NDs’ students is that of money. Our new Drs are leaving medical school with thousands of pounds of debt before they start to earn. Anyone in general practice knows what debt does to people. It is not nice. NDs’ team are sympathetic and will often allow students a little lea way from a 10 hour day to catch trains early so that they can get back to jobs to fund their education. This is very much the American way but not the traditional UK method of medical training.

Education, Education, Education was a catch phrase of our former Prime Minister and is entirely justified and a noble aspiration. ND believes that a meritocracy where the best, regardless of background, are trained to achieve the best in whatever they are good at is a noble ideal. This should, ideally, be provided for by the State in order to help the State, and its people, further as those that benefit from it will ultimately repay the State via taxation.

The previous Labour administration had maintenance grants which were abolished under subsequent administrations. Now students have a variety of sources of funding to help them on their way. Medical education is now very expensive for students and their families.

ND was not pleased to hear on the radio as ND drove through the dark wilds of Northernshire that the Party are reducing student funding due to their miscalculation. This will only have one effect.

It will reduce the variety of people applying to do medicine. Those who are able, but not affluent, will be put off. This will increase the selection of those going to medical school and further limit medicine to the able and affluent and thus reduce the variety of characters becoming Drs and deny opportunity to talented but not affluent people.

A few days ago a former deputy Prime Minister was bemoaning the fact that 7% of the population who go through private education get 80% of the top jobs because of money. I am sure that he will be pleased that those who go onto higher education particularly medical school will now have to be increasingly affluent rather than able.

ND does not think this is a good move and it would seem easier to get to and through medical school a few years ago coming from a less affluent background than it is now. This is not progress it is a slow return to an old world that was not necessarily a better one in terms of fostering talent and advancing people through education. ND and family all benefited from educational opportunity but looking at today’s times and opportunities doubt that they could have achieved what they did in the past today.

That is not progress it is preservation of the ancien regime by the Party many of whose children will be in the 7% going through private education. George Orwell was right about matters porcine and these things many years ago.

How little have we progressed and how far backward are we going?