Sunday, July 20, 2008

Fringe benefits

This is just unbelievable and, at the same time, so utterly predictable.
Medical teams could be rewarded with bonuses for successful operations under a plan being considered by the UK's largest hospital trust.

What the fuck? These people are to be rewarded for doing their job properly?

Medical teams are already rewarded for successful operations: it's a really novel sort of reward called "a salary". It's a reward similar to what most of the rest of us get; the difference is that if we in the private sector aren't "successful" then we get something called "the sack".

Of course, this is not a government initiative: it is a unilateral move by Imperial College Healthcare Trust, and therein, I think, lies the motivation. A motivation not entirely dissimilar to a little bit of American history.
With the 2nd world war raging in the 1940's, labor was in short supply, and the government imposed wage controls. To deal with this situation, employers begun to offer health insurance as a fringe benefit to attract more workers.

Indeed. And in the NHS, we effectively have wage controls, through the (insanity that is the) National Pay Deal.

And so Imperial College Healthcare Trust is attempting to attract the best labour through finge benefits, just as US employers did with healthcare insurance. Ironically, in this case, the fringe benefits are being offered to the healthcare workers themselves.

I still wonder where they think that the money is going to come from though; are they going to pay everyone for every operation undertaken? And will these bonuses count towards the employees' final pension payout? And what fringe benefits will Imperial offer once every other trust starts doing the same thing?

It's time to remove the NHS providers from state control. Oh, and forcing PCTs to split into Commissioning and Provider arms (as they are having to do) is not going to do the trick...


Johnny Norfolk said...

You could not make it up. The cannot manage anything so come up with cash give aways. What about the other end. ' If more people dont recover from operations you will be sacked'

Anonymous said...

Actually this is yet another example of the half assed economics believed in by the government and their idiotic managerial minions in the NHS. At first glance paying people by results is sensible. By paying surgeons for successful operations, surgeons will be incentivised to work harder, become more skilled and should result in better overall results.

But, thinking about it more clearly (after about 1 second of thought), what it results in, is that surgeons refuse to do tricky operations, as their chances of success are lower than their average and this risks lowering their remuneration. No one wants to do pioneering surgery (with higher failure rates, but a necessary part of improvement), so overall skill levels deteriorate.

Now, a rational person would give up on this totally dimwitted idea at this point. But, the foolish would come up with categorisation (more difficult, less difficult). But the categorisation system will be flawed (think about the number of variables: Smoker/fat/fit/age/other complications) and so inevitably, it will miscategorise a certain percentage of patients who will again not be operated on.
This is why a piece rate (per op)remuneration system is bad relative to a simple salary system. This government believes targets work. Most evidence suggests that other in the most basic situations targets simply warp incentives (as police and NHS bloggers continually point out).

This problem of difficulty of each op is one of the reasons why just publishing operational success rates for each surgical team is bollocks. The informativeness of the data is unclear. It also undermines much of the idea of patient choice.

Dave said...

Unworkable bollocks. Just what we've come to expect from this lot.
Of course, they can't just give the money out. There will be another level of burocracy and form filling, as we've come to expect. So, what have we got here? Another NuLab job creation scheme.
We patients only exist to keep these fuckers in clover.

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