Cavendish's comments on ISTCs and PBR are simply naïve. Too often, her articles read like a McKinsey brief. Funny that.
As for Johnson's spineless attempt at absolving Nulab's responsibility for top-down idiocy... I'm too angry to even type straight.
As a resident of the area, I can inform you that Tunbridge Wells' hospital - the Kent and Sussex - is known locally as the 'Kent and Snuffit'.
How can I stop funding this killer NHS?
Beurocrat rationed treatment? No thanks!
It wasn't all roses round the door everywhere in those far off days. In the 60s in Manchester there were problems with post-op infections and long waiting lists, with broad hints from your doctor that going private was the way to jump the queue. So my father, with good knowledge of NHS in West Yorks (from experience with my handicapped brother when we lived there), went to W Yorks for his hernia op, leaving behind a disappointed GP, paying the consultant in W Yorks a nominal 5 guineas because we lived out of his area, could have been done in 3 days, but had to make business arrangements first so opted to be done the next week, was done expertly under the NHS, and recovered very quickly. 45 years later my brother is still being well served by the NHS - he moved back to W Yorks and stayed there, even working in the NHS for 20 years (until managerialism crept in to his area).
May I commend the following article to lost_nurse:
http://
comment.independent.co.uk...icle3052320.ece
He puts his finger neatly on the problem.
I will make the following point. Even if you believe in the state spending our 'health' money for us (personally, I don't), why does it think it a good idea to run the system as a monopoly and employ the people itself? It would be far more effective were it just a commissioning body, free to contract from any supplier it chooses and representing solely the interests of the users, without any obligations towards the interests of the producers.
lost nurse
I feel for nurses trying to work in NHS hospitals. Like I say in the post, most of the ones we've met do seem genuinely caring types (although language is definitely a problem for many).
But they seem trapped by the system they're trying to operate. Authority is incredibly diffused, not least among all those quangos (see the Lawson article referenced by HJ and previous BOM posts on eg the hopeless National Patient Safety Agency).
As I've blogged before, for various reasons I'm a regular inpatient at a private Nuffield hospital. It's never had an MRSA case- still less c diff- and it's staffed entirely by ex-NHS nurses who all despaired and left the NHS.
The sooner we break it up and institute competing social insurers, the better.
dreamingspire
No, of course it wasn't all roses in the past. In the 60s the
NHS was still living off it's pre-Bevan legacy, yet it was clearly heading south.
Your story also illustrates how super-well informed you need to be to pick your way through the NHS jungle.
I'm not disputing either Lawson's concerns, or the need for action (especially as regards devolving decision making to the frontline). I'm not here to argue (today, anyway). Nonetheless, I bet you'll find a marked absence of feather-nesting on the kind of elderly care & acute wards currently being described in the national press. Such places are more like the Mary Celeste - lost, and drifting horribly out of control. The utter dislocation between frontline grunts and the big chief speaks volumes. Agency staffing running at 50%? Nursing care being cut (in part, to pay enforced PFI debts and the cost of a stupid bloody ISTC swindle*) so as to balance books? How much "producer interest" would it take for a nurse to stay in that kind of environment, day in, day out?
2/3 RNs + 2 care assistants is simply an inadequate level of staffing for a ward with 26 elderly, dependent patients (think: drugs, IV fluids, IV antibiotics, obs, bloods, cannulation, falls, pressure care, nutrition, incontinence, arrests, confusion, aggression, trying to provide some kind of comfort - you barely have the time to even talk to the WWII generation - plus, of course, documentation: because, in the courtroom, "if it ain't written down, it didn't happen"). With the fastest feet, and the best will in the world, you cannot do everything. But that's a pretty normal staffing level in my current hospital. And given the demographics, whatever system you envisage is going to have a hell of a job coping. C.Diff in an elderly patient, on top of an already complex (and deteriorating) presentation, with a high chance of a lonely death - this is not the kind of patient that BUPA has to routinely deal with (which is partly why their HAI rate is reported as being lower). Whatever change is a'blowing in the wind, it's going to have to be properly safety netted.
The reported incidents are appalling - but just as saddening, to my mind, was a vistor's observation that "nurses were holding their heads in despair." Would anybody swap places with them? I notice many tabloid journalists churning out cliches about carbolic soap (not aimed at you, Wat - your mum earned her opinions the hard way!) - but not much in the way of rational discussion. I'd like to see a full page article on antibiotic resistance in tomorrow's Daily Mail. Fat chance...
(*Apologies for swearing, but I'm still gobsmacked at the blatant Mckinsey propaganda that Cavendish comes out with - see also her take on MOD. I despise management consultants, and all their grasping kind).
lost_nurse,
The point is that the situation you describe is a symptom of the top down centralised monopoly that is the NHS. Some producers do very well out of it (many medics, some of the top management, etc.) and others - usually those with less power for whatever reason - do badly, as you describe, partly as a consequence of not having an alternative employer in their field of work. The point, however, is that this situation ultimately doesn't work in the interests of the user - which is the supposed point of the whole thing in the first place.
When we get journalists talking about carbolic soap, bringing back matron or whatever, it is, of course, pure nonsense - they have no special insight into hygiene issues. It should be the job of the supplier to work out the best solutions to their problems sure in the knowledge that the user may not be an expert, but he (or whoever commisions medical care on his behalf) has the option of spending their money elsewhere should they perform unsatisfactorily.
"When we get journalists talking about carbolic soap, bringing back matron or whatever, it is, of course, pure nonsense..."
Exactly. Shame that such nonsense sells newspapers. The Mail should drop the free Danielle Steele DVDs - and instead carry promotional copies of this:
http://intl.elsevierhealth.com/j.../journals/jhin/
.
Wat: Too right. The nose tells you all.
lost_nurse,
It's a depressingly low level of public debate. A bit like the argument over grammar schools vs comprehensives or phonics versus other reading methods in education. Everybody has their preference and they argue, in effect, that the state monopoly should impose it on everybody - regardles of whether it is appropriate for everybody. Let's say, for example that phonics is best for 90% of children. If it's imposed, it means that the other 10% also have to suffer it, even if it's not the best thing for them.
The solution, surely, is to have a choice. Different providers will offer different solutions and we will see which is best. Of course, you won't get the complete range of choice everywhere but ecomomics, as they say, operates at the margins - and is no less powerful for that.
One of the other problems of the NHS is that it isn't at all clear how much should be spent on medical care. The government decided to raise spending to the level of the European average (it's a bit above that now, I believe). But who says other European countries have got it right or what that money should be spent on? Who is to say that if people had more choice over it, spending might be only half as much or perhaps twice as much? Who is to say that, were there more price competition, providers wouldn't be able to work out how to provide things which are currently too expensive to be widely available at a lower price? After all, many industries and retailers have worked out exactly this over the years. The mobile phone market is a great example - we moved from a situation where a mobile was an expensive business accessory to onewhere everybody has one simply because suppliers realised that everybody would buy one if they managed to drive the price down. Overall, everybody has won out of this - the mobile phone makers and service providers have grown and the public has got more for less money. Inefficient mobile phone makers, however, have been (brutally) shaken out of the market and it is the public who has benefitted. Many common medical treatments could be provided far more cheaply than at present were there the incentive for the providers to work out how to do so. But when you have no competition, you have no such incentive, so the price stays high and production doesn't get more efficient.
Can I ask that you read the following 5 Minute read and then, if you see fit, disseminate the articles to as mant People as possible, thank you.
http://www.brusselsjournal.com/node/865
Video
http://video.google.com/videopla...873594&hl=en-
GB
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