Thursday, 10 December 2009

Britain's Survival Rates - A Knowledgeable Response

Clarinda is one of my readers who has a vast understanding of the NHS and its systems. I thought her comment on my earlier post showing the above graph may be of interest to those of you who haven't read it.

I suspect that despite our professional health care staff running ever harder to sustain what they can in terms of patient care (there are still remarkably good examples of the original principles of the NHS around) it must be so demoralising for them to see their best efforts in the face of incompetent managemnt and political decision-making resulting in the blame being laid at their door and not that of the real culprits. Perhaps this factor is a little similar to our armed forces being so professional in their duties with such poor equipment and dreadful political decisions overwhelming their potential?

I suspect that if you question a random group of doctors and nurses they will tell you in a blink where the money has gone - the transient, incompetent and oppressive deluge of management that has been politically imposed since the mid 70s which now accounts for the greatest spending explosion since the NHS began.

Management in our public services has become one of the largest growth employment rackets fueled by political interference and subjugation over the once respected and effective services once run by experienced health professionals. Patient care is also reliant on the 1000s of other health care Professionals Allied to Medicine (PAMs) who are also at the wrong end of managerialism.

Billions have been wasted on untried, experimental change, re-organisation, IT white elephants and 'modernisation' i.e. faffing about with non-clinically relevant or beneficial paper initiatives with the predictable consequence (inevitably foreseen by the doctors and nurses but brushed aside by management) of falling standards of patient care.

Training places for doctors have been cut and their training experience truncated - which are both predicted to become even worse in the next two years. Yes - salaries have improved - but if there are fewer trained/training doctors around - care and patient safety will suffer. The EU Working Hour Directive has further inhibited the potential of doctors to achieve requiste standards of experience and good practice. Many Consultant positions have been dumbed down to account for the lower quality and quantity of medical practice but this lower qualified position of Consultant grade allows the government to claim there are more Consultants! Yes, there may be but not as we once knew them!

The statistics, in their defence, are not comparing like with like when the origins of their data are considered. The USA may appear to have better cancer survival rates but this may be due to the omission of 1000s who die from cancer due to their lack of health insurance to access early diagnosis and treatment. What effect has our own 'health tourism' and immigration had on UK statistics and over-stretched services. Many arrive with advanced disease and disability not then ammenable to early diagnosis and effective treatment resulting in unavoidable death or chronic disease managemnet costs.

These graphs should propel us to demand a stop to politically motivated and managerial interference and return the NHS and many of our other public services to the respected and capable authority of the professionals whose expertise is currently marinalised by incompetent and costly managerialism. Of course the NHS needs managing - good managing!


JRB said...

If I may be allowed to repeat myself. -


May I compliment you on an excellent post.

It reveals the clear and distinct truth of all that currently ails the NHS, and bears the hallmark of one who works from within, hamstrung and frustrated by the sheer bureaucracy of it all, but who still fundamentally cares for the NHS and the people it serves.

For too long now those who manage and administer the NHS have been lost in a sea of policies, procedures, performance and protocols and they have lost sight of the one essential ‘P’ – ‘People’; be that the staff who work on the frontline of the NHS or the patients who depend upon the NHS.

subrosa said...

Of course you may repeat yourself John, as often as you like.

Beautiful day today - one in which to appreciate the winter sun. I think it's countrywide too which is a change from the norm.

Furor Teutonicus said...

I would not trust the graphs as far as I could throw a bloody Chieftain tank.

They are trying to say that Germany comes NOWHERE on ANY of them?

That is TOTAL bollox.

(von Spreuth)

subrosa said...

I noticed Germany wasn't included Furor although it is an EU publication the graph.

Clarinda said...

JRB - thank you for your comments.

I don't know if this alleged fact remains true but to indicate the remarkable number of managerial and admin. staff within the NHS, it was said that the NHS was the largest single employer in Europe?

Today we hear that Scotland's health budget may need severe restriction and even cuts. What an opportunity for the SNP to cut out the non-clinically relevant slack and actually increase or hold steady the current funding for frontline patient care.

I fear, however, that NHS management will hold lots of meetings to calculate the need for employing more office staff or increasing the hours of their part-time staff to look at ways of saving - what an irony!

I am sounding too negative perhaps - as in Scotland I think we still have the edge in general terms. But, however more enlightened our political NHS governance may appear to be, I still think there is plenty of scope for running a tighter, and much slimmed-down, managerial ship. I would like to hear from our professional Scottish medical and nursing bodies etc. a concerted plan, free from political sycophancy, on how they would advise and support their members to reinstate their organisational power-base within the NHS. Some of the most successful health care systems/models (and other public services) are based on ultimate decision-making resting in the hands of internally appointed professional staff within individual institutions. They work with a lean mean team of managers whose function is to make sure the whole process is possible within whatever funding is or could be made available to function effectively. This is not a complete power reversal but a much more intelligent co-operative process. The health professionals have the primary knowledge and perspective to prioritise the best interests of patient care and safety allowing the managers to manage - which in turn enables the professionals to function effectively! Some of the worst health care systems are based on absolute politico-managerial decision-making with the health professionals taking a secondary
advisory role with little real authority to influence or reverse managerial decisions.

No system is perfect but I think our NHS has deteriorated under the influence and authority of managerialism. I will attempt to find out how Germany's health care organisation work Furor - probably very well?

Oldrightie said...

Clarinda, quite excellent and incisive. Socialism does this, of course. It's about control. No better iilustrated than by a prime mentalist for whom someone has found a drug that works, for public appearance purposes.
The analogy with our armed forces is very apt. Death by neglect of management being as prevalent as in parts of The NHS.

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