torpedoed by Labour
Dr Andrew Morris
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The NHS has quite clearly hit a major crisis
– it is not a crisis caused by insufficient funding, ‘we’ve never
had it so good’, no it is a crisis caused by government policy,
meddling and a distasteful attempt to subvert what they see as the
illegitimate power of doctors.
The government have embarked on a ideological quest no less misguided than communist farm nationalisation. This quest has sought three things, to create a market within the NHS which is open to private providers, to control down to the smallest detail the activity of the NHS and to displace doctors from their role as the providers of medical care.
Each of these has been done despite clear evidence of increased cost and decreased quality – it is the antithesis of ‘value for money’
Examples of how the NHS has worsened despite more money
1) Out of hours in many areas you no longer get to see a doctor, just a nurse or paramedic with some ‘extended training’
2) A referral by your own doctor is screened by a clerk with no clinical training and redirected to whoever they think appropriate, this person may be a nurse, another GP, a physiotherapist but is increasingly less likely to be the consultant to whom the referral was originally addressed.
3) At night in hospital you become sick, it will no longer be a doctor who comes to see you –it will be a nurse. A nurse with some extended training no doubt, who has protocols for managing acute illness but not a doctor.
4) If you are lucky enough to be fit and healthy but need an operation you are likely to get this in a centre run by a company for profit, who will not follow you up and will dump any complications on the local NHS. The centre will use the cheapest materials it can get away with, the cheapest staff and still charge the NHS over the odds for this service.
5) Over the next few years increasing amounts of elective work will be performed by non-medical practitioners –from anaesthetic practitioners to surgical practitioners, physicians assistants etc…
Problem 3 is increasingly happening during the day time too. Whilst our protocol wielding brethren may well be able to cope with many common problems they frequently call on moderately senior doctors to help out. H@N (Hospitals at night) has worked simply because there are now more senior doctors in hospital at night. However a side effect of this is that more junior doctors training is suffering. Point 5 will simply worsen things further. In 5-10 years time who will provide the supervision these non-medics need, who will provide the expertise?
We hear today that in a couple of years time we will have thousands of unemployed consultants, but 14,000 too few nurses. What a surprise – this is a direct result of government policy and leads to the crazy situation that whilst the headache and epilepsy nurse specialists try to provide 1/3rd of a neurology service between them, consultant neurologists will be unemployed or retraining into their 40’s.
Of course all these reforms have been introduced because they are the ‘most efficient way of providing health care’.
OOH services were previously provided by GP co-ops which paid their GPs a very good wage but were cost effective and people could see a doctor.
‘Referral management’ ends up either requiring re-referral or costly management by non-consultants (see GPwSI [GPs with Special Interests] paper in BMJ). H@N is more expensive than previous arrangements.
ISTCs (Independent Sector Treatment Centres - private health) have failed to provide cheaper healthcare despite operating on only the easiest patients.
And anyone who swallows the line about
non-doctors filling medical roles needs only to look at the adverts
attached below – each one offering a salary in excess of most junior
[Ed: The problem could be that we have a probably psychotic and megalomaniac PM, with great self-belief, who knows he knows everything about everything, including that he is omnipotent (isn't that part of the definition of a megalomaniac?) but who knows very little about anything. In addition he appears incapable of thinking through any of his "reforms" to their obvious conclusions.]
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