Saturday, October 16, 2010

Lansley NHS Reforms: totally wrong. Grassroots-up, demand-side reforms needed

I tend not to blog about medicine much, partly because blogging is for fun, and medicine is my day job (though only one day a week, and I do that just for fun, so it is time I began blogging medicine. QED).

The NHS changes proposed by Andrew Lansley need a good firm smacking. The only thing he has got right is that medicine should be oriented slightly more to primary rather than secondary care. However, Lansley's organisational revolution is not the way to do it. Few GPs have the organisational skills to make it work, though we will be given a good media hammering in coming months by GPs saying it is a Good Idea.  These will be the GPs who stand to make a fortune by charing the new administrations.

My experience of NHS meetings tells me that the NHS is not good at organising decisions. What it will mean in practice is a hugely expensive change in letter headings from "Blogshire Primary Care Trust" to "Blogshire GP-led Patient Focussed Primary Care Trust." This is going to cost some £3,000,000,000 pounds for a pointless change, at a time when people are being thrown out of work in the name of deficit reduction.

Total madness.

And why are they doing it? In order to open the door that bit more for private "care" companies to get work from the NHS. Privatisation by stealth.

So Lansley's reforms are top-down, organisational changes designed for the convenience of private health care companies.  The NHS needs this like it needs a hole in its heart.

This does not mean that the NHS should just be left to carry on regardless. 
It does need reforming, but the reforms should be grassroots-up, not top-down.
There should be more concentration on the demand side of the equation, not just the supply of drugs and therapies.

In brief, this means improving public health with policies designed to reduce inequality, unemployment, sub-standard housing, reduce pollution, and promote social cohesion. This could reduce demand on the NHS by some 20%.

Secondly, GPs should spend a proportion of their post-grad education time simply exchanging information with each other on what works for them.

Third, all big organisations need a Suggestion Box Scheme.

Fourth, GPs need to be trained up in brief psychotherapy, clinical ecology and acupuncture in order to offset their reliance on expensive drugs peddled by Big Pharma.

I will try to explain what I mean in future blogs.



Call it 'deficit reduction' if you want but the majority of NHS spending goes to non front line staff/support. The NHS needs to lose a lot of jobs.

I work with a PCT and a Trust both of whom have surplus people (as compared to the private sector) doing the same job in different departments which could/should be melded together.

DocRichard said...

I agree that there is huge scope for reduction of managerial jobs in the NHS, which I mentioned in this post.

I am not sure that it is correct to say that "the majority of NHS spending goes to non front line staff/support. " It depends on definition. If nurses and doctors are front line, then there are porters, cooks, cleaners and maintenance workers who are vital but non front line. It is the back office managers, with the inefficiencies oyu mention, that are ripe for pruning.