The decision to recruit the former Chief Executive of Marks and Spencer to advise our NHS managers is the latest evidence of the consumerist healthcare model coming of age. I don't doubt that Stuart Rose will have plenty of suggestions for the current managers but what is he being asked to achieve? Is it just saving money or is it improving services? Or is it the political ideal which remains a combination of the two?
Either way, I'm not sure I see the merit in this latest step. Granted, our NHS is facing huge logistical challenges which are being worsened by the day. Advances in medical science and our existing obsession with evidence based medicine mean that national guidelines now exist for virtually every symptom faced by your local GP on a daily basis. The litigation culture foisted upon us from across the pond has ensured that medicine is now operating in a more defensive manner than ever before. It has no choice. A doctor not adhering rigidly to national guidelines now faces the litigious consequences if he/she doesn't. That only speaks of the current national guidelines from the medical side of the fence though.
What is being ignored by just about everybody is the numbers of patients presenting to emergency departments and GP practices for spurious reasons. Recent estimates suggest that as many as 40% of A and E presentations are inappropriate. The knock on effect on the hospital is considerable with precious man power being needlessly swallowed up. Many of those presenting to A and E complain that they have been unable to get an appointment at their local GP. They might just be right! As far as I know though, nothing is being done to follow up these people.
We can only improve our current NHS when we are aware of it's major shortcomings. If GP opening hours are not insufficient, I suggest we need to look at that. Likewise, we also need to address whether we have enough GPs on the ground. For fear of sounding overly simplistic, an effective Primary Care will exert huge relief on the currently stressed Secondary Care sector.
Stuart Rose may know a lot about the logistics of running a business but I wonder if he has an understanding of the biggest stressors currently impacting on the NHS? Far too little is being done in the way of patient education. If more people were made more aware of the simple decisions they can make to promote healthy living, much of the current overload would be reduced. For some, it may well be too late as the damage may already have been done. That is why, we desperately need to be targeting our children - and their parents.
The decision to legislate against smoking in cars with children on board sounds like the nanny state. But there is a perfectly good reason for this legislation. Stuart Rose has been brought in because he is a businessman and, to all intents and purposes, the NHS has to be run as an accountable business. With one small difference. The NHS is the only business I know of which remains free at the point of access to every man, woman and child. If we're going to continue with this promise, we need to start attaching certain conditions. Joe Public needs to understand his/her obligations in that deal - and it is a deal. While autonomy remains a key ethical principle, there has to come a point when somebody draws a line in the sand at the "free at the point of access" bit.
Recent figures highlighted the cost of treating alcohol related illness in the North East of England. That just speaks of alcohol - not tobacco, not sugar and not any of the army of drugs now on offer. That also just speaks of the North East of England which is after all just a small part of the whole. Addiction though remains a part of human culture and behaviour and the current spending on mental health and medical education is woeful.
If we all picture the NHS as a long piece of pipe, it's time to avert our gaze from the A and E department at the one end and instead focus on the people entering the pipe at the other.
No comments:
Post a Comment