Friday, 19 March 2010

Told you so

"So how do we save money in this Alice in Wonderland pseudo-economy?" And answer came there none.
"Do more work; see more patients?" Er, no.
"See fewer patients?" No.
"See different patients by changing efficiencies?" Still no.
"Do work for free?" Sorry - still won't work.
All because the organisation that 'buys' from us doesn't have the money to pay the bills for what we do. So it doesn't. But it still expects the same level of work to be done and of course it will be done as no sane doctor will turn away a sick patient.
And there you have the internal market in an unpalatable, zany nutshell. Business principles in the ultimate non-business environment.

I was talking to my mother-in-law the other evening and she was reminiscing about the birth of her daughter, my wife, as parents tend to do on the occasion of their offspring's birthdays. She fondly remembered being in a large single room for a week - yes you read that right: a week - after the delivery, being pampered by the nurses and able to recover in peace. These days, after an uncomplicated delivery she would be sent home inside eight hours. Of course we no longer have the resources to do the former but it does not necessarily make the latter better.
Not everything that can be counted counts. And not everything that counts can be counted. Information is not knowledge.

Monday, 8 March 2010

Here comes the rain....

So after months of dyspeptic rumblings the machine that is the NHS is now due to vomit forth its response to the global economic recession. Healthcare spending will remain static so in real terms it will fall and something needs to give. Because of the ludicrous system of 'them and us' for primary and secondary care described below hospital Trusts are victim to not being paid or work already done and work still to come. One cannot turn a sick patient away from the door (not in this country anyway) so this situation will continue. Regardless of the amount of work commissioned the actual amount done will inevitably exceed it and, in contrast to virtually any other business model, the more we do the more we lose. Crazy?
Never mind that by cutting a swathe through the countless layers of ineffective middle management saving huge sums and improving efficiency. Never mind that the sums involved bear no resemblance to the market price for services in the private sector anyway. Never mind that cuts now will not only not help the current situation but bear grave dividends in the future. No - my major gripe is that when we meet with the bean counters next week to try and thrash out a plan their only agenda will be to cut salaries, lay off clinical staff and close wards.
I shall ask them only one question: "How do we save money in this Alice in Wonderland economy?" And you know what: they won't have a clue because they have no idea what is being counted anyway.