No Plan, No Funds, No Staff

Junior doctors have been on strike this week, an astonishing thing to happen that, in itself, demonstrates the terrible political diplomacy that Jeremy Hunt, the Secretary of State for Health, has demonstrated as he attempted to push through his agenda.
Mr Hunt’s central talking point is that the policy he is pursuing is a manifesto commitment.  In interviews he suggests that the British Medical Association (BMA) is attempting to block the manifesto commitment, and therefore the will of the British people.
That is not quite true, for several reasons.  First, the manifesto pledge is for a so-called “7 day NHS”, the idea being that routine clinics and elective procedures should also take place at the weekends, when its more convenient for many people.  The manifesto pledge only says that hospitals will be ‘properly staffed’, and nowhere does it say that this will be achieved by reducing the out-of-hours pay for doctors (achieved by re-defining late evening and Saturday work as normal working hours).  It would have been an odd sort of voter who assumed that would be the case. Continue reading “No Plan, No Funds, No Staff”

The Pragmatic Idealism of Team Corbyn

How irritating.  I had drafted a short, blistering blog about how the NHS, the sacred cow of British politics, is a massive socialist project.  “If the NHS did not exist”, I would have said, “none of the Labour leadership candidates but Jeremy Corbyn would dare suggest we invent it”… And when he did, everyone (other candidates, the Tories, the media and yes, much of the British public) would have accused him of being a bonkers socialist, happy to squander billions of pounds of taxpayers money. Continue reading “The Pragmatic Idealism of Team Corbyn”

Hurrah for NHS bureaucrats

“I want doctors with stethoscopes not bureaucrats with clipboards”
—David Cameron, 2 April 2015, #LeadersDebate

In tolerant and inclusive twenty-first century Britain, there is still one group of people that the politicians are happy to demonise: NHS managers.  During last night’s Leaders’ Debate both David Cameron and Ed Miliband were happy to trumpet policies that would see a reduction in NHS managers and an increase in doctors.
This is obviously a vote winning policy.  It’s a simple zero sum equation that ordinary people think they understand.  When we experience the NHS, we see a front-line health professional, not a back-room manager.  So more doctors and nurses, with less bureaucrats, appeals to the natural biases we have due to the way we experience the health service.
But I was sat next to a doctor during the debates and she ridiculed the policy.  If there are less managers in the NHS, then the task of managing will fall to the doctors… Who will have less time to see patients and run clinics!  The admin load placed on doctors and nurses is already a chronic complaint.
The NHS is a vast, multi-dimensional organisation. Running it is a huge logistical challenge.  The doctors, nurses, and technicians all need to be paid, co-ordinated, and to have precisely the right equipment at their disposal when the patient turns up for their appointment.  This requires managers.  The patients themselves need to be piloted through a Byzantine network of ‘healthcare pathways’ as well as the literal corridors of the hospital.  This requires managers.
Moreover, the government and professional bodies set rigorous standards and targets for the service, which are meaningless if they are not monitored.  This requires managers.  And the facilities that power the health service are some of the biggest and most complex institutions in our society.  They need hands on the tiller to set a strategic direction.  This requires managers.
There’s no point in employing more doctors and nurses if you don’t also employ management staff as well.  Otherwise the medical staff will end up doing all the admin and that will be frustrating for everyone.
Hurrah for NHS bureaucrats!

“Amateurs talk about tactics, but professionals study logistics.”
—General Robert H. Barrow, USMC (Commandant of the Marine Corps)

An Enclosures Act of the Mind? Libel and the NHS

Here’s an article I posted yesterday on the OurNHS section of OpenDemocracy.

In many ways, the Defamation Act 2013 was good for medicine. During the course of the Libel Reform Campaign, English PEN met dozens of doctors and medical journalists who had been silenced by the famously restrictive English libel law. Pharmaceutical companies used the archaic law to prevent the publication of valid criticism by medical professionals. Fiona Godlee, editor of the British Medical Journal, told a Libel Reform rally how factual reports on medical treatments had been ‘softened’ or even spiked because of libel fears.
The Defamation Act 2013, which English PEN and the Libel Reform Campaign spent three years fighting for, gives strong legal protections to peer reviewed articles. Patients and commissioners should be able to learn of any doubts that doctors have about pharmaceuticals and new treatments. The Act also includes measures to limit the progress of trivial claims, and a new public interest defence. In 2007 Goldacre faced a libel claim from vitamin pill manufacturer Matthias Rath after he used his ‘Bad Science’ column to critique claims that these pills could cure AIDS. Although Goldacre eventually won the case brought against him, the battle left him significantly out of pocket. The new Act should help journalists like Dr Ben Goldacre see off the pharmaceutical libel bullies.
Continue reading “An Enclosures Act of the Mind? Libel and the NHS”

Health Tourism

Empty Hospital Ward at Hillingdon Hospital, Uxbridge, UK. Photo by Alex @ Faraway
Empty Hospital Ward at Hillingdon Hospital, Uxbridge, UK. Photo by Alex @ Faraway, Creative Commons Licence

Last week, I fell into a long discussion with a group of doctors on the problem of health tourism.  This, they say, is when people visit the UK specifically to take advantage of the NHS for treatment of ailments, major and minor.  In particular, women from Africa who think (or know) that they are HIV-positive will visit the UK in order to give birth.  Their children will therefore receive proper medical care and whatever medicines and retrovirals that the current clinical guidelines recommend.  My interlocutors were of the opinion that this was a major drain on resources, especially in the urban centres where they work.
For the avoidance of doubt, these were not the same medics who held the illiberal opinions of marijuana usage, but I did detect in them a slight note of discontentment.  Not intolerance, yet, but certainly exasperation.
If health tourism is widespread, then such feelings of irritation amongst the medical class are also likely to be common, which is not good.  More to the point, it would mean our health system is being abused, perhaps to the tune of millions of pounds.  Definitely not good.
My hypothesis is that health tourism is actually an extremely localised problem, centred around inner-London.  This is where strong immigrant communities already exist, and where health tourists can stay with British residents while they get their treatment.   If this is the case, then it is clearly a particular challenge for the health service in London, rather than a structural issue for the NHS as a whole.
I have put in a poorly worded Freedom of Information request to the Department of Health to find out what statistics are available.
Why bother, though?  What could we possibly do with this information, when we have it?
Simply put, quantifiable information on such an issue will immediately put it in perspective.  Is it a major abuse of the system that we could correct, or just another example of patient-led inefficiency that we will never eradicate?  My suspicion is that it will turn out to be the latter, something akin to the problem of hypochondriacs, that we know is a waste but nevertheless do not have the heart or the stomach to actually address (turning away pregnant Africans at the automatic doors never feels good).  Either way, it will at least address the mutterings of the doctors who see the issue on the ward floor, but have no sense of whether it is a problem beyond their particular hospital.
Second, it may allow for a rather deft sleight-of-policy at the Department of Health.  If the NHS is indeed providing millions of pounds worth of care to people it does not have to, over and above the call of duty, then they could with some legitimacy put that expenditure into a different accounting column.  They could, perhaps, claim it back from DfID or the FCO as a form of targeted, useful government aid.
Let us not be so naive as to think that my request doesn’t carry some risk.   While I do not believe that such statistics (whatever they may be) will actually inspire xenophobia, it is certainly possible that someone might try to use the figures to further some anti-foreigner agenda.  I’m not sure I know what to do about that, but I don’t see this possibility as a reason not to ask the question.  Better me than someone else, I reckon.
What do you think?
On the Ward in Bbowa, Uganda. Photo by Paul Evans. Creative Commons Licence
On the Ward in Bbowa, Uganda. Photo by Paul Evans. Creative Commons Licence