Another positive endorsement of NHS reform.
David Flook, consultant general surgeon at The Royal Oldham Hospital has written a scathing article (at least in Dr terms) in this week’s British Medical Journal.
Mr Flook says:
I would support many changes, including (despite a personal loathing of computers) better IT systems, but I do not trust our incompetent government to introduce them. I do, however, oppose the cynical, superficial reforms through which politicians have exploited the NHS. The fraudulent claims for these reforms are many and varied. [my emphasis-magwitch]
Patients are not ‘experts’ about which consultant to choose, that’s why we rely on the expertise of our GPs. They have the relationships and the knowledge that no ‘league tables’ can provide:
GPs are educated consumers of secondary care. We are fortunate to have two excellent DGHs close by. We know who, within those hospitals, are the good consultants. Most patients did not ask for a choice. They relied on our expertise to select the right specialist. – Dr Crippen.
But how can any layperson make a meaningful choice (best treatment, not soonest) from the vast NHS array, when even clinicians who have worked in the NHS for decades know little or nothing about the abilities of many colleagues in their own or other units? – Mr Flook
Then there’s the good old two week rule, as Dr Crippen explains;
The TWR audit officer, or TWR commissar as we shall henceforth call her, is not interested in health care. Her brief, her protocol, from which she will not deviate, is to ensure that all TWR referred patients are fast tracked. – Dr Crippen
In fact, fast track referral prioritises the worried well at the expense of the target population. Of the more than 300 such referrals I have received, only 14% had a cancer, while coincidentally, more than 85% of the cancers I have treated, including 98% of the potentially curable cases, came via other referral pathways, with no trend for improvement. – Mr Flook
Mr Flook also lambasts nu-Labour’s proposals to ‘ease’ the crises in hospitals by moving the problems elsewhere.
Grandiose schemes are proposed for transferring services from hospital to primary care, but how many GPs have the inclination or training to do this? Independent treatment centres have been introduced, sometimes regardless of the need for their services and employing staff who need not meet the standards for NHS appointees and whose treatment outcomes are frequently unacceptable. – Mr Flook
Dr Crippen has already given us the GP’s point of view in Quacktioner Alert (10)
In the end the problem lies with the government’s top-down approach that excludes those implementing the changes from having any say in what ‘improvements’ are introduced, and how:
The problem for NHS managers (which many acknowledge in private), is that politicians have replaced doctors in priority setting (essential in a cash limited system). Managers are now no more than foot soldiers implementing the latest vote-winning initiative and I have seen no evidence that management consultants do better at even greater costs. – Mr Flook
Can it be right that consultants are excluded from prioritisation of appointments by systems such as “choose and book”? – Mr Flook
You know things are a mess when eminent consultants are publicly denouncing commissar Hewitt’s brave new world in the NHS