Friday, January 18, 2008

The DoH is good at something

It's good to have Dr Crippen back, he's typically scathing of the government's failure to put the extra billions of investment in the NHS to good use, and frankly who could disagree with him? Well, maybe the odd moron, but certainly not anyone with a modicum of sense about them. What is the reason for this dismal waste:
"Micromanagement. The medical profession has not been allowed to do its job. The government has forced doctors to implement focus group predicated health care. Professional judgement is neither respected nor required. Doctors' morale is at an all time low. Medical care is now all protocols and process. Protocol driven medical care can be done by monkeys, and often is."
I don't disagree with this, but there are other significant reasons behind the wasted billions, and my opinion is that the top down micromanagement from the Department of Health, a top down control freakery that enforces a one size fits all strategy of ideological pants.

This recent example, as described by the ferret fancier, shows precisely how money is being frittered away. The DoH is ordering that privately run Walk in Centres be set up by the APMS (Alternative Provider Medical Services) route in PCTs up and down the country, no matter of the need for such a facility. For example in Oxfordshire's case, the access to out of hours care is excellent with easy accessible surgeries all weekend, a great 24 hour service that patients that are very happy with, as evidenced by the government's own access survey.

Of relevance hospital services are terribly stretched in Oxfordshire, with a real bed shortage meaning that the main hospitals are frequently on various kinds of alert and this can have devastating knock on effects for the sickest patients. The last thing the county needs is a Walk in Centre (WIC) and one can guarantee that even if the county did need a WIC, the tendering process would be far from transparent and about as competitive as the socialist's sports day. As always this process is deeply unpopular and antidemocratic in its nature, but the PCT must obey the DoH or else, locally controlled services my fragrant behind:
“Of most concern is the fact that no standards for quality of care are laid down for APMS providers. Their regulation will be through the contract that may never even see the light of day if deemed to be commercially confidential.”
This is a quote from Professor Allyson Pollock in the British Journal of General Practice. The NHS of old had its problems for sure, and was probably unsustainable, but at least decisions were made on clinical grounds and the system was pretty cash efficient. Labour have created a ridiculous Stalinist system which encourages the avoidance of caring for the sick, which spits on the autonomy of the medical profession and which wastes billions of pounds moving beans back and forth between various tiers of the management structure that are run by vacuous self interested cretins. The Department of Health is certainly good at one thing, pissing our money away in order further the political interests of a few despicable scumbags.


mitch said...

Off topic but thought you might like this "Political Correctness is a doctrine, fostered by a delusional, illogical, liberal minority and rabidly promoted by an unscrupulous mainstream media, which holds forth the proposition that it is
entirely possible to pick up a turd by the clean end."

verity said...

Dump the NHS! What is the great attraction of this Stalinesque outfit for the British?

Privatise NI contributions. Keep them mandatory but the salary earner should be able to nominate his healthcare provider of choice.

anthonynorth said...

I think we can take micromanagement deeper than this. We tend to have 'systems' in society that ape our knowledge and achievements.
In religious times, society echoed the glory of God and Heaven - or at least, they thought it did. Today, we live in a materialist, technological society, and I've often thought that the result of this is that our 'systems' will become machine-like - i.e. no deviation, no ability to use initiative, everything controlled so it seems to work in one way.
If this continues, initiative and deviation will become a thing of the past.

Sir Henry Morgan said...


That is exactly why, for some years now, I have called the 'system' ... 'The Machine'.

My 'Machine' is a computer. A computer works by following the instructions of a program. A program is nothing more than a set of instructions, protocols, procedures. It doesn't matter if the eventual output is bollocks, or if it is even damaging - the machine will keep on churning it out according to program.

That is exactly how the 'system' works. Hence 'Machine'. The clerk in the jobcentre, or the hospital etc will frequently concede that what he has to do is bollocks "but I can't do anything else, those are my instructions/procedures/protocols."

Absolutely no space for human initiative. Big business is going much the same way - try getting the muppet in the call centre to do something outside the box.

Sir Henry Morgan said...

And that's why one day they will be herding people into gas chambers, and nobody in the process from the cop that arrests you, the clerk that arranges the travel, the clerk that signs you in at the gas chamber will ever concede they did anything wrong. "I was only doing my job".

The only person that will be pinned down for eventual punishment will be the sap at the end of the process who actually dropped the gas in.

Haven't we heard this story somewhere before?

(wonderful word verification: whackdb. Appropriate eh?)

chris said...

Unfortunately this is how the NHS is supposed to work. It is supposed to have ministers fretting over the tiniest details, it was set up in order to have ministers fretting over the tiniest details.

That was what they thought would be best, get a sufficiently smart person with a sufficiently good plan and, they reasoned, that the result would have to be better than the messy products that had evolved to solve the problems before. So industry was planned from the centre, architects made "machines for living in", and the NHS where born and grew to fruition.

This experiment has been running for more than haft a century and the results are pretty conclusive. The messy products of evolution spanked the planners across their own drawing boards.

Central planning of industry turned into the 'managed decline' of industry. The 'machines for living in' crushed their inhabitants. The NHS manages to take first world levels of funding and turn it into developing world levels of service despite the best efforts of the staff, which if they had been in the private sector would be referred to as grossly exploited.

cookie said...

Dr Crippen does not like the current system. But my understanding of his comments is that he would not like any system unless it favoured a more socialistic system.

Before you criticise me, please get Dr Crippen to express an opinion that is diametricaly opposed to a socialistic opinion, rather than simply a partisan 'I don't like this current gov' one.

verity said...

Chris - I regard the NHS as a kind of cult. It makes no sense for people to speak of it with such awe. It returns very little for what they pay in. Yet people seem to fear privatising the whole thing. It's like a religious thing.

You could still have compulsory NI deductions, except the customer would nominate the healthcare company he wanted them credited to. I don't know why this is such a big deal.

Anonymous said...

Sir H Morgan:
"- try getting the muppet in the call centre to do something outside the box."

Quite, but I hope you don't imagine they can use common sense without being penalised and eventually fired for it. I did a stint as a 'muppet' in a tech support centre (never again), and there were more things you were forbidden to do for the client than things you could. What's more the 'muppets' would happily do things 'out of the box' just to get the job done - but soon learned that they would be 'disciplined' if they risked it too often. The cretinous bastards in charge of this shambles were solely concerned with their 'targets' for the number of calls answered, regardless of whether anybody's problem actually got solved - so quite often nothing got done simply because anyone doing anything would be penalised for taking the time to do it. It was just like the Soviet Union all over again, with lots of production targets being met, and not a lot being produced. A person's 'Key Performance Indicators' were generally inversely proportional to their ability and inclination to fix the client's problem, and the management seemed to be too stupid to realise this even when it was pointed out to them (as it frequently was) - or more likely they did realise it but were indifferent, because it was 'policy' handed down by the next tier of morons above them. Naturally anybody competent soon quit. I don't see any solution for it short of bloody revolution.