NHS Reform II - the 'disordering' of society

A few weeks ago, a GP friend told me he had been contacted by an undergraduate with 'Executive Function Disorder'. The condition had been diagnosed by educational psychologists after he failed his exams. The 'disorder' presents the sufferer with difficulties in: 'organising, prioritising and activating work'. In my day that would have applied to virtually every student I knew. The student, having been given short shrift by his current GP, had contacted the practice to see if they would treat the condition. I was reminded of this story when I was reading the Government's 'white paper.'

According to the proposals, the Coalition's ambition is to 'liberate' the NHS. From what it is being liberated, they don't make clear:  

'First, patients will be at the heart of everything we do. So they will have more choice and control, helped by easy access to the information they need about the best GPs and hospitals. Patients will be in charge of making decisions about their care. Second, there will be a relentless focus on clinical outcomes. Success will be measured, not through bureaucratic process targets, but against results that really matter to patients – such as improving cancer and stroke survival rates. Third, we will empower health professionals. Doctors and nurses must to be able to use their professional judgement about what is right for patients. We will support this by giving front- line staff more control. Health care will be run from the bottom up, with ownership and decision-making in the hands of professionals and patients.'  

As anyone who has ever stayed in a Disneyland resort will tell you, even the most 'magical' places can treat visitors like cattle. Massive institutions are essentially dehumanising because they have to process such large numbers and individuals can often get lost in over all outcomes. There is no doubt that requiring treatment within the NHS can sometimes leave you feeling slightly soiled. I'm sure you have had good and bad experiences. I'm not entirely sure what putting 'patients at the heart of everything' actually means, but, if it were to insist that everyone is always treated with appropriate dignity then that is a worthy aim. 

By calling them 'second rate', paying them less and removing decent working conditions, I don't think the staff are being treated with much dignity. Anyone who has worked in health care will know that the system has always worked through the 'good will' of many practitioners filling the gaps between their jobs and the work actually required. This is the 'vocational' aspect of the job. Turning the work into a contractual agreement has always missed this point. One of the shocks for the Labour Government, following the now infamous GP contract, was that they ended up paying for things that GPs had largely always done because they were good practice, not because they were paid. Despite what you may think, health professionals are still working over and above what their contracts state. Let's see the private sector bring that attitude to the table. 

Unfortunately, what the government means is 'no decision about me, without me.' The Coalition are selling us a wonderful vision: choice about what treatment, carried out by which top professional, where and when? All of this, of course, will be based upon freely available information with which to make a fully informed judgement. It sounds amazing, but, as 'JPD' commented on the blog yesterday, 

"I don't want a choice about where I have my kidney stones out! I just want decent treatment locally. I have enough stuff to worry about without trying to work out whether the decreased relative risk of dying is worth the higher cab fare."

We will all be affected one way or another. What about the families of the one in five of us who, it is now projected, will reach 100. Will they want anything but effective local services for the aging relatives? Anyone who has spent time researching a new TV purchase on the internet will immediately shy away from the thought of making like for like judgements on something as vague as medical outcomes. As one orthopaedic surgeon I know has pointed out: in a free market, driven by profit and with patients making judgements based on historical outcomes, no one will take on the difficult cases anymore. Why would hospitals or individual practitioners risk having their averages damaged? 

According to the Government 'patients will be in charge of making decisions about their care.' My friend, the surgeon, spent six years in medical school in London, another 14 years getting all his surgical examinations and also has a number of years experience on top of that as a consultant...and the patient is in charge? Perhaps they are big fans of casualty? As patients, we are already 'in-charge', as much as we can be. We say 'yes' or 'no', but there is a big gap between that and most patients being able to make truly informed decisions about treatment. The proposals insist that 'Doctors and nurses must to be able to use their professional judgement about what is right for patients' but one of the great myths that recent politicians have peddled and, I think is rife within society these days, is that everyone's opinion is equally valid. Everyone has a right to express their opinion, yes, but that is not the same thing at all. I don't want a hospital consultation that takes the form of a Radio 5 phone-in. Let's regulate the health professions in a thorough and credible way and then back their clinical decision-making. 

The response to the student was to tell him that 'Executive Function Disorder' is not an illness. They have drawn a line and said, "sorry, there may be something wrong with you but it is not a health issue." Perhaps we should back health professionals to do that more often. The 'disorder-ing' of our lives has reached epidemic proportions.  Forty years ago Woody Allen joked that, " I don't want to become immortal through my work, I want to become immortal by not dying." Unfortunately, I think many people no longer see this as an unrealistic expectation. Too often the punchline on Woman's Hour - don't tell the lads please - is 'if you are not sure, speak to your doctor.' It's as if the GP has become the secular world's  father / confessor. Is there any wonder the NHS is feeling the pressure.

Anyway, I must stop, the Mrs wants to have a chat about my 'Cricket on TV lethargy syndrome'. Amen.