Time was:
… When I was employed by a Regional Health Authority and seconded to a local Hospital. Consultants were thus “protected” though we hardly “whistle-blowed” and in those days only really “bad” doctors got suspended.
… When GPs would write personally to a named Consultant and the Consultant would take pride in providing the consultation and reply personally.
… When medical secretaries would take short hand and they took pride in what they did for a low pay, but it was for the common good.
… When junior doctors would learn not only from consultants but from experienced nurses and sisters (yes, sisters).
… When we accepted patients transferred back from private hospitals because the patients’ insurer dumped them or the private hospitals could no longer cope.
… When the only cancelled appointments were those with the wives, husbands, or family: patients always came first. One Christmas day I took a present to a young patient in hospital before going to friends for lunch. The family waited in the car.
… When we were respected and we knew it, and we were all proud of our NHS.
England then had 14 Regional Health Authorities.
Then>>>… London alone had 31 PCTs.
… Good doctors get suspended left, right and centre, for whistle-blowing or whatever.
… GPs cannot refer to named consultants, and in the case of psychiatry, to any consultants at all, but to a faceless committee.
… Appointments get cancelled many times as none were genuine appointments in the first place, but only given to satisfy the Patient’s Charter.
… We have a worst NHS structure than ever, with years of management expert advice only draining our limited resources. Note that the management experts collapsed the banks and we, the people, had to rescue them.
NOW:
There are 32 Clinical Commissioning Groups (CCGs) in London. Each CCG is a statutory NHS body with its own governance arrangements; these vary according to its Constitution. CCGs are membership organisations of the practices within their boundaries. They are responsible for meeting the health needs of their populations and their main focus is on local issues.
I know, the old days were not perfect, but things worked well enough and management was only 6% of total NHS spend. In 2005 it was at least 14% but we do not know as those who knew did not want us to know.
"Whatever the benefits of the purchaser/provider split, it has led to an increase in transaction costs, notably management and administration costs. Research commissioned by the DH but not published by it estimated these to be as high as 14% of total NHS costs. We are dismayed that the Department has not provided us with clear and consistent data on transaction costs; the suspicion must remain that the DH does not want the full story to be revealed. We were appalled that four of the most senior civil servants in the Department of Health were unable to give us accurate figures for staffing levels and costs dedicated to commissioning and billing in PCTs and provider NHS trusts. We recommend that this deficiency be addressed immediately. The Department must agree definitions of staff, such as management and administrative overheads, and stick to them so that comparisons can be made over time."
If reliable figures for the costs of commissioning prove that it is uneconomic and if it does not begin to improve soon, after 20 years of costly failure, the purchaser/provider split may need to be abolished.
If the new government really wants to care for the people of this country and I think they do, they have to start taking advice from where it is offered FREE, from genuine people who love to see the NHS work.
Our NHS is not a BUSINESS, and should never be, as patients are not, and should never be treated as commodities.
Pass the patients back to us: the doctors and nurses.
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