Comrades, we must do more hip replacements

Two truths inescapably collide:

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1. Command economies always fail

2. NHS waiting times targets are being achieved by deception.

The odd thing is that the first point classically relates to socialist planning with top down orders regarding tractor production/hip replacements, regardless of resource, but the second point is being publicised by the British media’s most fervent apologist for such failed socialist models, Ms Polly Toynbee.

What did she expect? You can’t have it both ways.

In The Knife’s own hospital, since New Labour introduced targets, there have been difficulties. In truth, the medical establishment had become jaded and complacent about how long people waited. Although we hated to admit it, targets brought improvements, if accompanied by resource, either financial or staffing.

However, it soon got to the point where the completely arbitrary nature of the numerical target got in the way of health care. I have yet to meet the patient who is genuinely fazed by the difference between a manageable 12 week wait for elective surgery, and a completely unrealistic and expensive 9 weeks. It’s that simple.

So, Polly professes shock that admin and clerical staff are subtly coerced into dodgy fiddles, hidden waiting lists, suggestions that they wait for their original surgeon (which is actually quite a reasonable thought) and so on. The politicians don’t actually care – I know, because I’ve tried to engage them on this – as long as it doesn’t affect the election message: “waiting times at all time low” or some such bollocks. And if these nefarious practices do emerge,  just shoot the middle manager.

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Polly’s solution is always the same – spend more money. When Gordon Brown did this after 2001 it created the biggest expansion of  pointless public sector employees ever, thereby helping trash what was left of the economy. Try comparing the NHS in 1948 to now.

The Knife’s solution is to apply logic. Meaningful dialogue with working doctors (not the BMA/Chief Medical Officer), preservation of cancer targets and a simple stratification of elective targets to include urgency and case complexity.

There’s no sign of it happening as things stand. My God….this could become the second argument for the NHS reforms.

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