Bottom Up?

I listened this morning to a discussion on the radio about the plan to give doctors power over budgets in the NHS. During the discussion, someone in favour of the idea mentioned that this would be an end to top-down management. I future, decisions would be made ‘bottom up’. I disagree. GPs are ont at the bottom of the pile. That space is occupied by the patient. Indeed, in the British system, the GP already has the power of gatekeeper to NHS services. In my view, that is too much power. It is already very difficult for patients to be referred to specialists. That situation will worsen as GPs weigh the cost of a referal to their budget.

Interviewed a little later, David Cameron admitted that the UK health service performs worse than many other European countries, despite having about the same spend. Yet, in the same interview he expressed his devotion to the NHS, apparently unaware that this financial behemoth is the cause of Britain’s weakness on health.

Author: tomkilcourse

A sceptical Mancunian who dislikes pomposity and rudeness.

16 thoughts on “Bottom Up?”

  1. I agree with much of what you have said Tom, apart that is about patients referrals. Patients have had, for quite some now, more access to a choice of specialists. From referral date, patients are seen within 6 to 8 weeks, which is greatly improved on what the waiting time used to be. Many are offered appointments sooner than that in a lot of cases, nationwide. Okay, the NHS is pretty crap in a lot of areas, but not quite all.

  2. Hello, Val. I am pleased to hear that referals have improved in terms on waiting time, though what you say conflicts with what has happened to relatives of ours. Nice to hear from you, keep smiling.

  3. Unfortunately, no British politician has the cojones to admit that, while the NHS was a great idea, its implementation was and remains a disaster. It needs to be scrapped and redesigned from start to finish, but that would cost a lot of money and jobs (not in health care but in administration).

  4. FEEG – That’s socialism in a nutshell. Great in theory, particularly if you are on top of the heap guiding the lesser mortals, but absolute pants (I believe the current vernacular is) in practice.

    OZ

  5. Tom, it is the shibboleth of all UK political parties’ politicians, to mouth devoutly about the sanctity of the NHS. FEEG has it about right. Val, up here it can take up to twelve weeks to see a consultant and I have had to drive to Glasgow on occasion from the Inverness area to see a consultant who wasn’t there, and his secretary didn’t consider it necessary to telephone and tell me he wouldn’t be available, before I started the 350 mile roundtrip. On other occasions I have had first-class service and care in a local hospital from locally-based surgeons – nothing life-threatening, but they were clearly concerned for their patients and cursing the bureaucracy of it all. Most of my life overseas I have had access overseas to private medical care. You phoned the doctor, who would ask when it would be convenient for you to see him. That is patient-driven medicine. Here there seems to be a rat race to phone as soon after 8 a.m. to be granted one of the scarce appointments available for that day. It is quite impossible to say that there is no great urgency, and you can see the fellow you want to see, next week, to be told, Oh! That isn’t possible – the system doesn’t allow for that! Thank God, I am not chronically ill. The whole thing seems hopelessly haphazard, and can veer from one extreme to the other. On the one occasion I did need something done, in recent years, I flew to Paris and had an excellent specialist tackle my DuPuytrens Contracture with a fasciectomy in about 15 minutes, for £40. EasyJet cost me more than the surgeon. ( I blogged about it on my own site, some time back)

  6. I think you need to live with a health care system to judge whether it is ‘better’ or ‘worse’. The statistics prove nothing. Witness the Danish services. They leave much to be desired.

  7. I agree, Janus, that statistics don’t show everything but not that they prove nothing. If the figures show that cancer survival rates in the UK are lower than in other European countries, that is not meaningless. I have experienced both British and French systems, and the latter is far better from a patient’s point of view.

  8. Like I’ve said on many occasions, don’t believe statistics 100%, with figures plucked from nowhere, not just within the NHS. Statistics are like media news, they are produced to shock, scare and get people moaning, and it works well, doesn’t it?

    Most hospitals and GP practices put up monthly notices showing all the DNA’s (did not arrive)for that month. three quarters didn’t have the decency to phone and cancel their appointment; all those failed to attend appointments could have been offered to other patients. If everyone played correctly, the system would be at least 50% improved. To repeat again, the NHS fails in a lot areas, but there again, so do other organisations, its because as humans beings, when we want something, we want it now, as our right; life ain’t like that I’m afraid.

    It’s also worth remembering, you will never hear about all the successes, you will never hear of the lives that have been saved, you will never hear of the people that have survived cancer and similar diseases, they don’t produce those figures; it would take up far too much time to tell the world that. It’s easier for the media and politicians, to give you the bad news.
    There is no perfect system, Why? because it’s abused.

  9. Interesting stuff Tom,

    Statistics can be massaged to support any argument.

    One of my biggest bug bears is the sensationalist reports in the meeja about “operations which cost £20,000”. They have come to this figure by looking at the wages of the theatre staff, cost of the equipment and facilities, instruments and consumables. Imagine if that operation had not gone ahead and the OR was empty for two hours, the only expenditure which would have been saved would be the consumables and the cost of sterilising the equipment again. Everything else would be paid for anyway.

  10. Val, I think you make a very fair point. Too many people who use the NHS expect to be treated as if they have gone on a paid vacation. “It’s my right”. There is such a tendency to the visit the doctor for the mildest of ailments. The system could be run a whole heap better, that is for sure, but that would require a change of mindset throughout the UK from politicians, who use it for their political ends, to administrators who are hell bent on keeping their jobs and increasing their salaries, to medical staff many of whom do not really possess the vocation, to the media who wish to sensationalise every defect, to the patients many, many of whom are a bunch of whingeing hypochondriacs and so on. Then of course there are the drug companies who create drugs that serve no real purpose, but who use a sort of moral blackmail to get doctors to prescribe them.

  11. Sipu, you are spot with your comments. Drug companies do have far too much control, and dictate to government. Get rid of all the managers, and I do mean all managers, and reinstate Matron.

  12. The NHS has many faults – true. Certainly it needs a shake-up – one based on the expertise of the medics rather than administrators with no medical knowledge.

    But the NHS is there when people need it – and it’s free. My aunt has just died in the USA. Hours of talking with my cousin confirms to me that my Mum is far better off under the NHS than my aunt was even with her Health Insurance. How many people in the UK are made bankrupt by their medical bills?

    As it happens, I don’t think that GPs should have control of their budgets, any more than I agreed with heads having control of school budgets – neither are trained in the sort of financial expertise needed in the running of their ‘businesses’.

    I also tend to think that the NHS could save itself a lot of money if it confined itself to dealing with disease, injuries and other related matters rather than trying to put ‘right’ the hand that Nature has dealt: Nose-jobs on the grounds of ‘psychological trauma’ and infertility. But maybe, I’m too harsh – I had no problem with my nose or infertility.

  13. Janus :

    Sipu, when did you last use the NHS?

    Probably about 6 years ago, but I can’t imagine it has changed much except become more bureaucratic. In October 2003 I was sent by my GP to the Charing Cross hospital to arrange some treatment. I was told it would be 4 months before I could make an appointment. Not, get the treatment, just get the appointment. As it turned out I was out of the country for the next few months. When I returned there was a letter from the hospital saying that they had arranged an appointment for me but unless they heard from me within two weeks, they would cancel it. The two weeks had expired a week earlier. So that was the end of that. What I had was not life threatening, just a physio problem with my knee, so it was not a major concern. But I was pretty appalled by the way they managed things.

    During my time in the UK I suffered from reflux. I was put on treatment that was supposed to last about two months, but shortly after I stopped taking the treatment, the reflux resumed. So the doc renewed the prescription. This went on for several years. When I came to SA, I realised I would have to pay for my own treatment. So I asked a pharmacist for the price of the drug I had been taking and for an over the counter equivalent. The latter was a quarter of the price of the former and, as it turned out worked just as well. In fact I discovered after a while, that I need only take it once a week as opposed to every day. All the while my NHS GP had thoughtlessly been prescribing something that neither he nor I was paying for. Cost the NHS an effing fortune, though. It makes a big difference if you have to pay for your own medication and treatment. You think twice. That is why I believe patients must pay an excess on every treatment they receive from the NHS.

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