Dr Blue on Reformation by Shredding

Labour’s reforms of the NHS are reformations in the same sense that a piece of paper is reformed by being shredded. They are reforms in the same way that a sinner is reformed by being burnt at the stake.

The language of reform has been misappropriated so that “change” comes to mean “reform” This linguistic slip has enabled a Labour government to unleash its domestic version of Operation Shock and Awe on the NHS and pass it off as “improvement.” All opposition to the so called improvement must be crushed as “a force of conservatism” or as “misinformed and badly educated”

I am well educated and I am fed up of Chairman Patsy’s uplifting little homilies. I would love the gales of creative destruction to blow through the Department of Health and flatten it.

I wish to reclaim the English language as a tool for direct communication and so expose the travesty of targets and activity that currently masquerades as thought and action. I have listened to Professor David Hunter describe the current NHS changes as “Incoherent, back to front, contradictory” at a meeting In Bradford in November 2005. Things don’t look any better now,
as the Lancet describes.

The biggest failure of this new Labour Government on health has been its inability or unwillingness to generate any coherent thinking about what is either needed or wanted from a healthcare system. The word that must not be named here of course is RATIONING

The justification for the NHS is its equity and its universal population coverage. Also that it controls overall health expenditure within the economy. The Americans have low equity, high cost, non-universal medicine that is good if you have enough insurance dollars behind you.

The difficulty with the NHS is that its laudable equity is equally bad, rather than equally good, for everyone. The current talk about high quality, dependable local services is a joke as there is no real competition to the NHS, so no real comparison is possible. The distorted version of competition that the government and its pals in McKinsey’s and other management consultancies have dreamt up bears the same relation to market competition as a gargoyle does to a portrait.
David Craig describes how it’s all been done in his useful book and the
review here is a good summary.

I suspect patients would be realistic if told that NHS resources are finite, and cannot provide everything for everyone. Already the NHS has given up on long term care of the elderly, a lot of optician and dental work, much chiropody, most infertility treatment and most plastic surgery. People seem to have adapted to this, although the Scots have gone back to providing long term care for their old folk without trying to separate out the nursing from other care needs. (The current distinction English social service department have to draw)

Most patients want accessible services, good communication with staff and good follow through on problems. They do not like inaccessible services, long waits, bad communication, having to repeat themselves multiple times, seeing a different doctor each time. As a GP I try to cater to these needs but everything in the NHS is making it harder for me to achieve and deliver what patients want.

Money goes not into more GPs, or better premises but into new stand apart facilities whilst existing NHS infrastructure is run down and staff laid off. The PCTs grow ever larger (back into the district health authorities that they started from, progress being a circular concept in the NHS) and ever more managers are recruited, but they don’t address the fundamental problems of lack of space and lack of real workers. They get in sound good initiatives like community matrons but block GPs getting extra practice nurses. They can get “five a day” health promotion workers but they can’t get dentists. Harriet Sergeant exposes the problem well here.
The manager working for £40K wonders why he cannot get radiographers on £25K in central London.

The current NHS changes are a disaster waiting to happen and they deserve opposition. They are no way in which to run any health service sensibly. As at present set up they will bring misery to patients and staff, and Labour politicians deserve to get it in the neck from their voters.

Whether the Tories can do any better remains to be seen.

However I can state with confidence the view that this current government is a disaster to the NHS and deserves evicting from office as soon as possible, on grounds of its NHS record alone.

The fact that teachers tell me that schools are just as bad only adds to the feeling of terminal incompetence that surrounds the end of this government.

And let’s not ask the troops in Iraq and Afghanistan how they feel about things.