The NHS is shit. Patients wait too long to be seen in substandard facilities by staff that are over-run or don't exist.
The NHS does not need to be shit. There are lots of excellent facilities in the NHS - good departments that provide an excellent service.
The NHS is shit because it is ground-level-underfunded, top-level-overfunded.
The NHS is shit because it has been corrupted totally by politicians who only want to hear the stuff they want to hear.
The NHS is shit because the money is all going to Big Business and Big Pharma and is not going to front line patient care.
The NHS is shit because the staff spend 90% of their time doing paperwork.
The NHS is shit because care is being provided by the wrong people - nurses are doing the medicine, untrained staff are doing the nursing, and doctors spend most of their time trying to get management to do what management should have done without having to have doctors threaten them with bodily violence first.
Is getting rid of the NHS and replacing it with a social insurance system the solution? Lots of people think so. Some of the Dr Rant team think so.
I've worked in the NHS, I've worked in the private sector, I've worked abroad.
I think a NHS properly run is the solution.
I think large for-profit companies are a really bad idea for patients.
I think in 10 years time we will have lots of healthy, happy, middle class voters who can see a GP at 11pm while doing their shopping at Tescos.
I think in 10 years time we will have lots of unhappy, chronically ill, elderly and vulnerable patients who are getting no/shit care because they are not the customers that are wanted (the Starbucks Effect).
I think in 10 years time the UK will have Blue Cross ads on the TV featuring a sad woman sitting on a sofa saying 'I wish we had had Blue Cross insurance for the cost of prescription medications before my husband got cancer - I lost my husband, I lost my home, I lost my car, I lost my job - I lost everything'.
I think in 10 years time I will be watching all this from abroad with my kids thinking, thank fuck I saw the writing was on the wall and got the fuck out.
Monday, October 08, 2007
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Well the UK and its failed social manipulation experiments are ever more being shown to be failures.
We have social security system which encourages folk who are least able to bring up kids to have them young and get provided with housing by the state. While at the same time actively discouraging those who could best bring up the next generation from doing so.
We have an education system not based on selection by ability, or hard work, or even the spend of the parents, but rather on the postcode you can claim to live at. Which sustains through the generations the shit areas with the shit schools attracting shit teachers and forcing away the decent parents and so it goes on. Fair and just it is not.
We have a health system where complete evil useless tossers like the CUNTS running Coventry PCT are still able to draw their state salary while being held in complete contempt by all of their informed customers and stakeholders. A health system that rewards failure. A health system which is also dependent on postcode.
All these systems are in meltdown. They fail to leverage the natural human motivations. They fail to leverage competition. They fail to help people aspire to improve their lot. They fail to leverage the normal consumer pressure of taking their business to the best provider forcing the shit providers to improve or close.
Just in case you have not noticed we already have "lots of unhappy, chronically ill, elderly and vulnerable patients who are getting no/shit care"!
Improving the NHS is not the answer. Changing the NHS into a state backed insurance company where the patients can take the payouts wherever they dam well like is the only way forward.
But you are right on one thing, the NHS is shit.
Postcodes you say?
Of course the generous and benign nature of medical insurance companies and their penchant for generating goodwill and social justice would completely ignore postcodes when quoting premiums and cover wouldn't they?
I can identify chronic disease by post code alone in my practice area. I don't have the ability to deny the right to register on postcode alone. This makes my life difficult and stops me getting my handicap down to 9 from it's current 12.
Apparently everything will be OK once hospitals achieves foundation status - that's what the bigwigs in our Trust seem to think anyway ?
and I think you're right, dr rant team. So, as I age and decay, I cling to the BUPA policy I really don't believe in, ideologically, and am planning to try to keep enough in savings for stuff that doesn't cover; and boy, do I make sure I eat incredibly healthily... but then I can afford to do this so long as I live simply.
Meanwhile we need to fight these (can't find an adequate noun)
Now hear this (you market and or insurance lot)
Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration
http://www.nytimes.com/2007/10/07/us/07medicare.html?_r=1&oref=slogin
etc..
(dr mustard, I know I'm really only repeating your argument.)
no one, your state-backed insurance scheme could only work if there were a guarantee that all claims would be met... my BUPA policy was previously a Lloyds TSB one. When they had to pay up for a knee condition, they waited till the physio signed me off (stupidly telling them I wasn't actually 'cured') and then told me they wouldn't cover it any more (because it was 'chronic'). Before I could challenge that legally they stopped offering medical insurance... (coincidence, but an unhelpful one) BUPA have guaranteed to pay for knee ops if I need them, but their policy doesn't cver physio...**
**that is not the end of the world as UHW's outpatient physios are great; but there is of course a waiting list...
It says something for the system when the patients and the staff are both as equally unhappy.
I agree that the NHS should be given a change to be shook up and have clinicians taking the whip hand rather then somebody in whithall with little or no knowledge of working in a hospital.
I do disagree with the statement of nurses though I know this is bacause your making the analagy of the transitions which may be pushing doctors away from their roles. Which is true, though mostly all nurses (and students such as myself) try to do what we can for our patients. Sometimes we can all get very disillusioned by it all. One thing you failed to mention was then unemployed Doctors, Nurses and physiotherapists and the hospital support staff who have been the vistims of job culls. I forsee a future where the NHS will be for the poorest in society only, and with private companies being paid for by the majority for treatment. That will lead to great variance in treatment I fear as people opt for differing levels of insurance.
That's shittier!
Dear Dr Rant
We ought to apply some scientific method to your views on management as I have read a lot of your thoughts on their defects but not much about an explanation.
If we accept the premise that management is not very good or positively harmful what is the hypothesis? Is it because 1) they are hamstrung from above, 2) well intentioned but intellectually deficient 3)just dim 4) malicious 5) some other explanation
Any thoughts?
I'll have a go at answering.
I suspect most managers are reasonable intellectually- Many very qualified indeed. Some are over-promoted nurses.
Most well intentioned.
Most personally presentable and sensible. Many hacked off/in survivor mode at present- often worse than doctors and nurses.
The hypothesis is that stated in the management spaceship.
http://www.drrant.net/2007/03/management-spaceship.html
Perhaps the attempt to manage medical practice is actually a forlorn mission de novo. Like Diogenes, the original cynic, I'd actually like the management to "get out of my light."
I sense managers are basically the right people given entirely the wrong job specification. Milton Friedman explains exactly why this happens in any state organised bureaucracy.
Anonymous - may I commend the ferrets sublime take on NHS managers ?
You can find it at;
http://ferretfancier.blogspot.com/2007/08/nhs-manager.html
I suggest you empty your bladder before reading it though - you have been warned ;o)
So Dr Rant-
Do you think that I should stop applying and actively trying to continue my training in the UK and just stay in Oz? I want to come back but I cannot get a job and I have an excellent CV, excellent referrences from supervisors and now patients. I am good at what I do (physician type).
Should I accept the writing is on the wall and laugh off the UK?
Incidentally in Oz when i say to a local that they have to pay for their treatment there is no wailing and nashing of teeth. They just look at me as if to say "of course, how else do you get care provided" and it simply is not an issue (on the whole, there is the odd state sponsered scab over here too). Do you think that this is an Ozzy thing?
Dr Sniper
The article is right: the big companies want the NHS money, but the last thing they want is actual sick people - especially long-term sick people.
And if you were running a medical insurance company for profit, would it be cheaper to pay doctors, or to pay administrators to refuse claims on the basis of small-print? The way insurers make money is by taking in as much as possible in premiums and paying out as little as possible in claims - probably one of the least effecient ways of providing medical care.
The stupidity of a market-driven policy is already apparent - with PCTs/hospitals etc. already more concerned with offloading (financial) responsibility than actually curing people.
I do wonder what the NHS would be like if all the extra money that has been poured in over the last decade had been given to medical professionals so they could use it to cure people. But then we might not have such cool mission statements.
"the big companies want the NHS money, but the last thing they want is actual sick people - especially long-term sick people."
I don't know what sort of parallel socialist universe you come from - I'm not suggesting you are lying, just living in a very different society - but here in Australia if you need a mastectomy you pay your anaesthetist two hundred bucks, the insurance company pays out the rest and that's that. I accept that there are the truly poor out there who need the social safety net but I just bought an ipod at the tech store and flat-screen TVs are going like hotcakes. Based on my UK experience I just know that many of the exact same people would be besides themselves if they had to pay for medical care. Oh I forgot, seventeen years of specialist training doesn't justify the customer actually dipping into their pockets for the service. That's left for the barely-literate guys that served me today. /rant
Mark - just to point out that here in Oz the private insurance companies are legally obliged to provide you with medical insurance irrespective of your past medical history. They are only allowed to load your premiums for age AND NOTHING ELSE. In the UK that is very, very different. The insurance companies do not cover you/are not obliged to cover you for pre-existant diseases and their complications.
Unfortunately, Herring is right. Chronically sick people are bad for business in the UK. OZ is a different matter though. If you pays your premiums you gets your cover. Of course you need to find a specialist then. Occasionally a prob outside of cities..... a different issue.
Dr Sniper
Well Dr Sniper I imagine Parliament could fix that problem very, very quickly if they actually wanted to get things sorted out. Unfortunately given the obsession that Brits have with "free" medicine introducing such legislation has become a peripheral matter rather than the central focus.
By the way does anyone here think that the NHS wants the long-term sick or the elderly any more than the private health companies? I was sickened by the treatment of the aged in the "care of the aged" units I worked in in London. It's painful to even reflect on what I saw happening.
I suppose that the centre of the problem is that the NHS, a free, non-profit service, is being run like it is a actual company whose only reason to exist is to make profit. That obviously cannot work as it is impossible for the NHS to make profit as people to dot pay for treatment (apart from taxes, do they count?)
I was sickened by the treatment of the aged in the "care of the aged" units I worked in in London
Yes. It isn't all terrible everywhere but there certainly is far too much maltreatment of the elderly in hospitals. (Of course any maltreatment is too much, but you'll know what I mean.)
Dr Sniper:-
I recommend staying in Australia and completing at least one more year of training here. Chances are, positions will open up in the UK (after the NHS creaks, groans, and almost bursts) and your training can be accredited (subject to RCP UK approval).
Or, you could just get your FRACP :).
Care in the Australian system could also be improved, but it is mostly an issue of staff numbers and relevant training issues... but that's just not relevant here.
Elisabeth,
Based on my experience in Oz, care is better in Oz than the UK. But I live in a privileged part of Oz. I have not done city work. I am rural, but not real rural.
I will have to do the FRACP if stay. There is no other route to consultancy. My RCP boss at my hospital cannot understand why I see this as a drag. Yes, it is the same exam again (kind of) but I am a different person with kids now. The second time round my day to day motivation is less. Most people pass it once, not twice. These exams hurt the first time. I am damn sure they hurt this time too.
Dr Sniper
PS I am sure the FRACP is a valid exam. As much as the MRCP is. 2 times does seem crap though
Liz/Beth -
Oz is lovely though
Dr Sniper
this blog is so funny. If you are not busy playing the role of the gutter press, or muck slinging, you are peddeling more of this obnoxious self indulgent twaddle. I suggest team rant climb down out of their ivory tower, yank their heads out from waaaay up their asses and take a look at themselves for a change.
What a tit. Probably a non medic. If it is the same Anon who posts the usual "let the money follow the patients twoddle" at least he or she has changed his creative writing style.
Dr Sniper
re "this blog is so funny..."
yep exactly
they sit there as GPs slagging off the whole of the rest of the world, but fail to acknowledge the failings of GPs as a body corporate in the UK, and as such they are part of the problem
no one
If you want to see GPs slagged off just keep reading DH press releases, Brown's speeches, and their lackeys in the Times.
GP is not perfect but it works better than most of the rest of the NHS. It will be fully appreciated, with all the wisdom of hindsight and regret, after multiple enquiries, when this government has destroyed it.
We aware of GP's blind spots, but we are writing this blog as an act of advocacy for better general practice, and the removal of those people and systems that hinder us from delivering it.
re "advocacy for better general practice" go on then go for it, we are all ears, what do you suggest to sort out the shittier inner city crap GP services?
what you gonna suggest for the clearly underperforming GPs?
"but we are writing this blog as an act of advocacy for better general practice, and the removal of those people and systems that hinder us from delivering it."
hah!
Really? And there was me thinking it was just an excuse to insult people you happen to disagree with you and your opinions. annonymously mind you so that you never have to take the flack you dish out to other people who are brave enough to put their names to their opinions and discuss life and politics without resorting to name calling...
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