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Thursday, 27 August 2009

NHS reform

The NHS is a hot topic, most people want to defend it, reform it, remove it, etc. etc.
I'm very much in favour of the concept that treatment is distributed according to need rather than ability to pay.

Nigel Edwards raises some interesting points in his piece in the Independent.
Bits that caught my eye:

"How we move on from politicians being caught in a trap of being expected to act only to be blamed by the media is not at all clear: there is an expectation of accountability. The move to put more providers at arm's length through the creation of Foundation Trusts was an important step in this direction. But perhaps we all need to be braver, and stop expecting politicians to be the fall guys for everything."

"Do we also need more transparency? Certainly, there is much to do to improve measurement in healthcare. However, surprisingly, the evidence suggests that patients do not extensively use published quality information to select hospitals where it is available. The real effect of publishing information is to engage the professional competitiveness of clinicians rather than influencing patient choice."

"Sadly, the enthusiasm of professionals for improvement has been squashed by the top-down direction of the last 30 years."

"The pleas for more managerial freedom and better quality management are absolutely right. I know many fine NHS managers, although the quality of middle-tier management is variable. However, I wonder why anyone, particularly talented clinical staff, would want to go into healthcare management when it is such a vilified profession? This needs to change. We need to challenge the assumption that management in healthcare is just a worthless overhead. Much of what goes wrong with patients' experience of healthcare is to do with systems that do not work as they should and fixing these is a managerial task."

As with anything worthwhile, there are no easy answers. How to rid front-line staff of paperwork is possibly the easiest topic, certainly from afar. But those forms exist for a reason, and one which must be tackled. I'd like much of that removed to allow more time for actual treatment of problems. Removing paperwork must be a priority, as is pumping money into front line services, but that's easier said than done.

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