Thursday, November 1, 2012

NHS & Railway: Specialists & JFK

Seeing the light:

© 2012 Am Ang Zhang

There is little doubt that the privatisation of the NHS is following the privatisation of British Rail in a perverse fashion. The separation of Track and Train operation is now being applied in an inverted fashion to health care in England.

The money is “given” to GPs via CCGs and health care will now be “bought” by them from anybody they wish to buy from. Most of us can see the flaw and unnecessary cost of such a market system and with a limited pot of money, the wastage on administration will approach that of the US system not to mention gaming and fraud that will lead to unnecessary treatment and its consequences.

In health care, death is irreversible.

The tension between GPs and Hospital Consultants in this country is historic and the success of Andrew Lansley and the Health Bill is more or less the result of the tactical play of that tension.

It is undeniable that the change of GP contract leading to a very skewed financial reward has meant that the average Hospital Consultant is lagging behind in financial rewards. This is most unusual in the Western world.

Many medical graduates will try and pick a specialty that may promise a better private practice reward if they want to become a specialist or else emigrate if generate practice is not their scene.

England leads the world of medicine for many years and most of us from Hong Kong came to receive our specialist training here. After all an English Physician did managed to diagnose JFK’s Addison’s disease (1947)when the best of America couldn’t.

A Hospital based health service:

The Cockroach Catcher has many medical friends working in different health care systems and most of my friends find our GP system ‘unique’. They see that progress in medical science has meant that it is difficult for a generalist to be able to do everything. Many medical procedures require specialist training.

Growth in most other countries has been in the area of specialist doctors.

The UK is the only country in the Western Word that is defying the trend. The serious side effect is that soon we might be running out of specialists in this country: well trained specialists.

So, what would be so wrong with a Hospital based integrated NHS.

My suspicion is that it will happen but it would be the privateers that will be doing it to have full control of cost that would be escalating. 

It is already happening in the US and believe you me, it will here. By then it will be too late as the specialists would have left the state run NHS.

The Light: For those who thought Labour would repeal the HSC Act, you have a shock coming: Labour never re-nationalised the Railways, so they would never re-nationalised the NHS.  Looks like next time too, it would not be an English Physician that would help to diagnose an American President.

Mayo Clinic: Disincentive system that works.

Disincentive system that works.
Virtually all Mayo employees are salaried with no incentive payments, separating the number of patients seen or procedures performed from personal gain. One surgeon refers to this tradition as a ‘‘disincentive system that works.’’ Adds another surgeon: “By not having our economics tied to our cases, we are free to do what comes naturally, and that is to help one another out. .  .. Our system removes a set of perverse incentives and permits us to make all clinical decisions on the basis of what is best for the patient.”

These are values that can be traced directly back to William Mayo and Charles Mayo, who, together with their father, William Worrall Mayo, founded Minnesota’s Mayo Clinic in 1903. The Clinic was one of the first examples of group practice in the United States. As Doctor William Mayo explained in 1905: “The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary…it has become necessary to develop medicine as a cooperative science.”

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