NHS management for the extremely thick

Isn’t the NHS great, basically? There are three chunks of “acute care” in order of clinical priority:

1. Life threatening emergencies – car crashes, ruptured appendix, heart attacks etc

2. Life threatening urgent – mostly cancer

3. Elective – everything else, joint replacements, skin clinics, psychiatry of  old age etc

Which bits are politicians obsessed by? Well, as usual, it’s reverse order, 3, 2, 1. Hence the ludicrous array of targets for quantifiable activity such as cataract surgery, joint replacements and so on. Note also that there are huge chunks of NHS activity that are less easy to measure, and so the politiians don’t pick on them – if you’re a  psychiatrist, life drifts on as it always has for many of them.

The cancer targets are a good idea, if frequently set at unattanable levels, given the wording they use. The elective targets are completely overcooked, making attaining them highly expensive, and diverting the NHS staff resources disproportionately. There is a happy medium to be determined here, no politician is interested in discussing this.

Both these areas are seen as votewinners by interfering political morons.

The bit they ignore is the first – emergencies. There are some silly timing targets for our overworked A&E targets, mainly to avoid the vote-losing spectre of patients on trolleys in corridors. However, it is always assumed that in the middle of the night a highly skilled surgical team will pop up and save your life. Money and development has not gone into this area meaningfully for years.

In fact, virtually every year leads to a U turn about closing minor casualty units, even though they distract from organising care for the critically ill and injured, and are becoming impossible to staff safely. Politicians – I love them.

So, The Knife welcomes the debate that’s been brewing for a while. Can we cut the NHS? Yes we can!

Simon Heffer today:

Take me to the DoH..

“If there were genuine risks of patients suffering, then the Tories would be foolish to cut the NHS: but the main casualty would seem to be a job-creation scheme organised by Labour to massage the unemployment figures, to appease the trade unions and to shore up its vote. Patient care doesn’t seem to come into it.

Every job in the NHS should be subject to an audit of its usefulness in delivering a health service free at point of use to those who need it; and those deemed unuseful in this regard should be removed from its payroll. Someone also needs to get a grip of NHS priorities. It should fund only what is necessary. Cosmetic surgery, other elective procedures and its support of various fringe medicines should stop. The ultra-generous GP contract should be reviewed. The whole NHS procurement operation needs to be reappraised. Most important of all – though this no doubt frightens far too many horses – failing hospitals should have their management contracted out to the private sector. Those with the political responsibility for health care must stop fearing the unions – white- and blue-collar – and get on with making the NHS live within our means. If that means redefining the NHS’s role, restructuring it, or even introducing a French-style insurance scheme, so be it. It is no longer 1948. The world has changed.”

There are risks with the private sector, as The Knife’s observation is that the management there is  no better. In fact a lot of the NHS managers are extremely good, it’s their political masters who are crap. I made a few suggestions on a previous post.

So, prioritise emergency and out of hours care,

treat cancer,

back off on elective targets a little,

review wasteful public health projects,

rein in the GP’s

– what’s the problem? There isn’t one.


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