NHS 'reforms'

[StraferJack]

Well Dave, what I think is that my telegraph link was reporting and your telegraph piece was opinion

As for efficient models, what is the target level of efficiency? If we accept we don't want to be where we are, where do we want to be?

% of GDP?

Some other measure?

http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

It irks me when defenders of the nhs concept are dismissed as ideologues while reformers see themselves as above such na?vet?

[DaveR]

Thing is, if you regard the NHS as essentially inviolable in its present form you are taking an ideological stance by defintion. The basic principle of the NHS is that all public health provision is provided through a single, public, tax funded organisation, directly answerable to central government, and that the provision is free at the point of delivery. It is a model that automatically precludes any other model being deployed (note the NHS ban on co-funding). Supporting the maintenance of the status quo necessarily implies a belief that this model is better than any other and, crucially, that no other model should be tried "the NHS is being privatised/betrayed/undermined!!!).

I don't think that is a sensible, or rationally defensible position. I apologise if you find that irksome.

[StraferJack]

Ignoring which system is best (and invalidating your accusations that I am along the present system inviolable) we can judge on outcomes can't we?

[david_carnell]

DaveR - the problem with that approach is that it is almost impossible to reverse the reforms that are being made. So when, and if, they fail there isn't a way of going back to the older, better, system.

[StraferJack]

Even if one objectively agreed with all of the changes currently underway, it would be foolish to trust the current precarious government to implement them properly

It's almost as if they know they are doomed so are pushing as fast as possible (see also major and rail privatisation)

Now THAT is ideology in action

[first mate]

I am told by a number of extremely stressed friends within the 'system' at Director level, that the damage (and damage is the word) is irrevocable.

[Marmora Man]

first mate Wrote:

-------------------------------------------------------

> I am told by a number of extremely stressed

> friends within the 'system' at Director level,

> that the damage (and damage is the word) is

> irrevocable.

If your friends are at Director level surely they can make things / change happen / prevent the wrong kind of change happening? After all that's the role of senior management?

The majority of GPs I interact with are in favour of the recent changes and the fact that they have the financial clout to make choices. They do not, as was the case last year for a Primary Care Trust I know, have to contract with a large and bureaucratic NHS Trust with poor cardiac surgery outcomes in order to bolster its flagging finances - they can, instead, send their patient(s) to the hospital / unit / specialist that they deem best for the patient.

When I was in the NHS I was frustrated at the slow pace of change, the lacklustre approach to quality and the, relatively, poor quality of junior management - tho there were pockets of incredibly bright, strong and effective management also. However, in the face of problems I did manage to make my little bit of the NHS a little bit better - more cost effective, more customer focussed, more responsive.

I left to manage a medium sized private hospital where I was responsible for everything and now a decade or so later I'm managing the equivalent of a medium sized DGH and again responsible for the clinical and commercial effectiveness of the service and where patients are, absolutely, at the centre of what we do.