The curious incident of the word in the weekend

So 48 hours into the trading and bargaining that will eventually result in our new government there is a word that has, to my intense dismay, not even been mentioned. Health.
What plans do our political masters have for the service? It seems that it is but a secondary issue. Never mind that it is the country's largest employer with 1.3 million people, nor that the waste within it would in these financially constrained times account for massive savings if properly managed, nor even that access to it it is a key measure of social equality. The talk is of economic cuts (watch out there!), divisions over Europe and voting reform as the main areas of dispute between the parties. The current crippling bureaucracy of targets and stifling paperwork, quangos and internal market financial squabbling will remain untouched to eat away at the morale and quality of a service that should be the best in the world in both ideals and quality. Granted, the two parties currently in discussion have not too dissimilar views on making administrative cuts but the magnificent over-riding pledge to abolish Strategic Health Authorities - those costly, non-visionary, paper-pushing, interfering nuisances - belongs to only one. Without swathing cuts like that the rest will be mere window dressing and so the outcomes of these negotiations is crucial to our immediate future within the NHS.
"Do a deal with Nick", should be the mantra in Whitehall. And not to form a Coalition of Losers either. Will it happen? Maybe.
But chin up though. At the current rate we'll be voting again in the autumn.

They think it's all over - it's not

So it looks like a hung parliament. Vote something, get... what exactly? No one really knows. The current options are a minority government, a coalition between the Tories and the LibDems or some regional parties or, unbelievably still, a Labour plus something alliance. (Surely this last cannot happen: how much of a 'no' does it take for these people to hear? If they had a shred of decency then they - ah... I've answered my own question).
The losers could include the NHS. Little will change if all the energies are directed at shoring up power and fighting for each and every vote for every debate. Targets misguidedly set by Labour would then be here for some time yet as there would be no one to wash them away. Health service funding would fall in real terms and natural wastage will be the surrogate for job cuts. Services might slim down a little but essentially they would reduce. Unless a strong government is formed to mitigate this potential disaster.
A hung parliament. Health service rationing. Get used to it now. Would electoral reform help? Again, no one knows but we might have a chance to find out rather sooner then 2015 as the uneasy alliances fragment. What should today's political slogan be? For the sake of the health of the nation: "Do a deal with Nick".

You couldn't make it up

As if the tale of the bizarre 'them and us' way that health service funding is run could not get any more convoluted and bureaucratized there is another player on the block. This week we were told that the result of the annual negotiations that are held between Primary and Secondary Care Trusts to thrash out how much the former will pay the latter for work done above and beyond the contract had a new result. Usually the sum arrived at is somewhere between the true figure of over-performance and zero and both parties retreat, grumbling, into their respective corners to work out an equally inaccurate contract for the next year.
This year however the leviathan that is the Strategic Health Authority - a body whose function is to set the overall plan for the way in which health services are run within the region - stepped in and fined each party a million pounds.
Yes - you did read that correctly. Each Trust, instead of either earning money for work done or paying for services received, did neither and had to pay this huge sum to an unelected third party where it will be frittered away on more needless administration. The result of course is that both Trusts now have even less to spend on healthcare and for the first time in my career I have heard the word 'rationing' as applied to the NHS. Not the very expensive cancer drugs or the post-code lottery of access that occasionally pops up in the news but real, sweeping rationing where 'need' and 'want' are distinguished and patients may have to pay for non-essential services: the example given to us was varicose vein surgery - as this can be thought of as cosmetic.
And here, during an election campaign, the government is not going to want this to come out for general debate - however wrong it might seem.
Strap in, folks: the US passes a healthcare reform bill to, at long last, start giving its people some decent healthcare; we however are dismantling and killing our system. Start saving now for this will only get worse.

Five a day? Try ten.

So eating five portions of fruit and vegetables a day only reduces your risk of cancer by 2.5%. Not worth doing then, clearly, as our no effort, instant gratification society will see this as reason to eat even fewer a day.

In truth the reduction is less than expected because five a day is not even close to what we were atavistically designed to eat in the centuries before the high fat, shrink wrapped, sterile, tasteless convenience garbage that passes for food all too often these days. Ten a day might come closer but even this needs to be seen as a part of a wholesale dietary change rather than the current perception that eating these portions as well as the usual junk will suffice.

But when we are still at a stage where supposedly intelligent newsreaders ask what exactly a portion is then we still have a long way to travel. Our ancestors on the forest floor knew a thing or two.

And they're off

So the phoney war is over and we are now due to endure four weeks of wall-to-wall unverifiable promises by the men in grey, who appear every four or five years to pretend that they understand and care what really goes on outside Westminster.
The health service should of course be a central pawn in this battle and numerous suits will promise that 'the NHS is safe with us'.
In reality none will dare to meddle too much with this jewel in the British crown but will nevertheless be unable to resist detrimental fiddling when the winner(s) is/are announced. But they will all ignore the elephant in the room - or perhaps they are genuinely so wrapped up in their own inflated rhetoric that they actually do not know. The service is managed and bureaucratised to distraction and the doubling of the number of managers over the last ten years appears not to have been noticed by those who seek cuts. Regulation has stifled innovation and progress and the army that drives this inertia-creating industry will be in no danger from the eventual winners.
And there lies the lost opportunity for vast savings and increases in efficiency and morale that cutting a swathe through these pen-pushers would create.
So vote for change, fairness, both or neither. It all adds up to more grey.

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.

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.