It’s a bit of a con to just recycle other blogs, but there is a brilliant post at Burning Our Money, which finds the right words to express something that has been bugging me for a long time.
The Knife works in the NHS, and is very well aware what a great job he has. The NHS is a cushy employer and there is the usual range of employees, even/especially at consultant level, who range from idle sods to extremely hard workers.
One of the problems, which is just getting worse and worse, is the conviction of politicians, that there are easy votes in bringing waiting lists down, and down, and down. This is well past the point of common sense or even the wishes of many patients. It costs a lot of money, and it can completely destroy the doctor-patient relationship that most of us feel is a very good thing. If you have decided to let someone stick a knife in you, then it seems like a good idea to have met them before, and discussed the details.
Burning Our Money also has a pop at patient pathways, which are actually just a neat way of organising an admission and its attendant documentation. They are not intrinsically a bad thing.
Anyway, to quote BOM:
“The NHS is continuing a journey of improvements, moving from a service that has rightly focused on increasing the quantity of care to one that focuses on improving the quality of care.”
A journey of improvements – aka Marxist-Leninism. The Dictatorship of the Proletariat is a necessary but temporary stage on our journey to a workers’ paradise of plenty and fairness for all.
What my Lord was trying to explain away was the latest evidence that organising healthcare as a Stalinist meat packing factory is a shocking idea. Patients get treated as lumps of condemned offal, staff get deskilled and demotivated, managers… but look, don’t listen to me, listen to the government’s own assessment report – a report they tried to suppress:
“The patient doesn’t seem to be in the picture… We were struck by the virtual absence of mention of patients and families … whether we were discussing aims and ambition for improvement, measurement of progress or any other topic relevant to quality… Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experience of care…
The GP and consultant contracts are de-professionalising, and have had the peculiar effect of simultaneously demoralising and enriching doctors. We’ve lost the volitional work of the doctors and far too many of us are now just working to rule…
The risk of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.”
And that’s the entire problem with Big Government – the needs and preferences of individuals no longer count, and our public services end up serving a bunch of arrogant ill-informed commissars closeted miles away from the action, who in many cases don’t even use the services they are inflicting on everyone else.
Yet despite manifest failure right across our public services, the so-called Progressive Consensus still seems to think that Big Government is the best way forward. Just like Stalin, they are prepared to accept as statistics the deaths and broken lives that result from Big Government failure. They are prepared to accept the costs and inefficiency that Big Government always entails.”
A very neat summary indeed...