Amongst other things outside I had planned a walk round the
woods this morning and then I wanted to get slabs into the bottom of the area I
was digging out yesterday. I was a bit miffed to wake to find heavy rain. Ho
hum…
I contended myself with making toast and my usual look at the
Internet. It was still there, and there wasn’t a lot happening in there. Mind
you I did learn something today. The monkey from the 1960s TV show “Lost In
Space” apparently had its teeth removed as it kept
biting people. There’s a sign of the times, eh? Could you imagine that
happening today? Biting people would be the monkey’s inalienable right,
wouldn’t it?
I munzed, got Wordle at the fourth attempt, and seeing the
rain was showing no sign of letting up I put some washing in, and cracked on with CPD. As I did
so my piss boiled. Lord Darzi has reviewed the NHS and found quite a bit of
fault, and my professional body have published their
response to his review.
Is the NHS going to have radical change? Is my professional
lot going to change massively?
Short answer – I doubt it.
Long answer… I’m reminded of my grandmother listening to a
cousin jabbering on at great length loudly and noisily about the equally
pretentious proclamations of the committee of the local fishing club, whilst
actually doing nothing himself other than sitting on his bum and finding fault.
Gran listened patiently to his ranting then announced “fine words butter no
parsnips”.
And this is true of both what Lord Darzi has found and the
IBMS’s response.
Lord Darzi’s report highlights the rising number of people
living with multiple long-term conditions and the strain this places on
hospitals. To address these challenges he says that immediate action and a
strengthened diagnostic infrastructure are needed to ensure early detection,
continuous monitoring, and better management of chronic diseases.
Can’t disagree there.
He goes on to say that a shift in the NHS’s focus from
hospitals to community-based care is essential, and claims that expanding the
reach of diagnostics into community settings will enable earlier interventions
and reduce pressure on hospitals.
We can’t argue with that in theory, can we?
But in practice? Lord Darzi has done reviews of the NHS
before. He feels (probably rightly) that the NHS is too big and would
work better in smaller units. However at the time of his last review of the NHS
pathology services were reviewed by Lord Carter of Coles and he said “big is
better”, and successive governments spent twenty years working along those
lines. I’m breaching no confidences by saying this; it is a matter of public
record. Just read the newspapers or watch the news.
If Lord Darzi wants diagnostic testing out in the community
with a massive increase in point of care testing he needs to staff it. So he
can either de-skill the workforce, and we all saw how that went (on national TV!), or he can
recruit a *lot* more biomedical scientists. And he can only do that by
making the job more attractive. And that will cost.
And that’s just the part of the NHS about which I’ve got
more than a passing acquaintance. The same is probably true everywhere in
healthcare.
On reflection I can’t help but wonder if Lord Darzi has
missed the point. The whole point of a hospital is that it is a centre of
excellence. If you’re a tad poorly you go ask the pharmacist for some jollop.
If his jollop don’t work you go see your GP. If whatever is wrong with you is
beyond him, you go to the hospital. And if your ailment is particularly out of
the ordinary your local hospital will send you to a tertiary referral centre.
The whole point here is that health care ain’t cheap, and there are massive
economies of scale by centralising. It is far more cost effective (and
practical) to have a single team of surgeons and the entire operating
theatre kit and kaboodle at one central location rather than having one at each
of a dozen (or more) GP surgeries in every town.
Having said (ranted) that, personally I’m taking
whatever Lord Darzi has to say with a pinch of salt. Whatever he says simply
won’t happen. At the risk of appearing to be an old reactionary, I really have
seen it all before. Many times.
There will be all sorts of meetings at the Department of
Health. Meetings, meetings about meetings that have happened. Meetings about
meetings that are to happen. Eventually NHS Trusts will get orders from these
meetings… and at the very point where something might actually happen, Lord
Darzi’s ideas will be superceded by the next great NHS shake-up.
Look at what Lord Darzi is suggesting… he feels that (effectively)
those in community-based care will call the shots in the NHS. That’s been done
before (at least twice) and abandoned both times because of political
ideology rather than any tangible evidence.
What the NHS needs is a load more money to recruit and
train staff. And having recruited and trained staff it needs to be left alone
for whatever is the current review and shake-up to take effect. Realistically
this will take a few years.
Then this current review and shake-up needs to be formally
reviewed and assessed, and fine-tuned on the strength of verifiable objective
data, not the whim of whatever politician is in vogue at the time. As happens
all the time.
The Prime Minister claims to have a ten-year plan. Perhaps
he has. Perhaps he will review and reform the NHS properly. Personally I hope
he does and I wish him every success. But a ten-year vision from a politician
is a brave thing.
I try not to blog about work, but sometimes…
