Tuesday, July 16, 2013

NHS Consultants: Successful, Skillful and Sought After.


Nothing like the reeds of Finland as I sat there fishing for Perch and Vendace to remind one of the old NHS and its Consultants.



©2012 Am Ang Zhang

After all Finland has one of the best State run Health Care without having to make a song and dance about it. Children receive free healthy lunch and when I last visited for a conference some years ago, I was most impressed with its mother and baby inpatient units to help young mothers cope with the early months of child rearing. None of these shot gun “adoptions” started by Tony Blair.

Some of us might still remember the times when becoming a consultant in the old NHS was a prestigious thing and that has nothing to do with the monetary reward. Once appointed, many would have some private work whilst keeping the main NHS consultant post. After all, there is only so much to be made in private medicine and in England it really depends on the discipline. In my hospital, the Ferraris were driven by surgeons and some orthodpaedic surgeons. Oh, we did have one Geriatrician who seems to be making a fair bit of money and drives a range of really up market cars.

There is thus quite a difference in the earnings of the different disciplines but having the same pay scale for all disciplines and across the whole country was a very smart design for our NHS. On top of that having the same pay across the whole country barring London allowance have meant that it was a bit easier to recruit to some areas.

Whoever designed that is a true genius.

Hospital Consultants then had a fair bit of say in how the hospital should be run. And generally it was well run.

Then came Thatcher, Major soon to be followed by Blair and Brown. Each had a go at dismantling what was essentially a good community service: on the principle that only some of us would fall ill and it is fair we all share in the cost of health care.

The problem with the NHS Reform is the NHS itself. Because it is still to be funded by Taxpayers, there is much money to be made.

It would be different if we separate out Private Health Care and State provided one.

That the management consultants found out a long time ago. No! No! No! Let Private Providers make money from the so called NHS.

Soon the government will discover that money would drain from the state to Privateers with no improvement in the actual care delivered.

Is it really that difficult to grasp! I wrote a little while back:

There is a good deal of time and effort wasted in discussing GP commissioning and some lip service paid to integrating Primary and Secondary Care.

Yet, those in power had little regard for Parliamentary democracy and all the signs are that Privateers are waiting in the wings like the Barracuda for its yummy meal.

Most people in well paid jobs (including those at the GMC) have health insurance. GPs have traditionally been gatekeepers and asked for specialist help when needed. If we are honest about private insurance it is not about Primary Care, that most of us have quick access to; it is about Specialist Care, from IVF to Caesarian Section ( and there are no Nurse Specialists doing that yet), from Appendectomy to Colonic Cancer treatment (and Bare Foot doctors in the Mao era cannot do the latter either), from keyhole knee work for Cricketers to full hip-replacements, from Stents to Heart Transplants, from Anorexia Nervosa to Schizophrenia, from Trigeminal Neuralgia to Multifocal Glioma, from prostate cancer to kidney transplant and I could go on and on. China realised in 1986 you need well trained Specialists to do those. We do not seem to learn from the mistakes of others.

When there are not enough specialists to go round in any country money is used to ration care. Just look at Canada.

There is unfortunately little realisation that soon, a large number of consultants would no longer be working in NHS Hospitals.

Stent, Hips and others

They will be working for Private Hospitals that initially will be offering services to NHS patients. But because of shortage of the said consultants, those that are concerned that at 78% obstruction, their heart and life may not last the wait and they will pay for the job.

                                    US $ 50,000 for Stent Procedure©Am Ang Zhang 2011

My friend just did in Hong Kong: a bargain at US$ 50,000.

What about your painful hips, the CCG may decide to impose a wait time to limit cost. So you too will pay for it. That is what my golfing friend did in Flroida for a bargain US$90,000 as he paid a co-pay of 25%.

So there are not enough Consultants and shortage creates demand and you can name your price. Consultants do not really want to waste time in CCGs arguing about the price of Stents or Hips.

Soon with changes in the amount of private work FT Hospitals may do, what successful, skillful and sought after Consultant would want to stay within the NHS only to have his pension contribution increased and ultimate pension reduced.

Why not be 100% private and where are FT Hospitals going to find consultants for the phantom private patients.

Private hospitals will continue to provide NHS work but more to fill in their money making gaps. Very smart management indeed.

Consultants in private hospitals are generally extremely well treated, not like the way CEOs of old NHS Hospitals used to sideline them.

In Hong Kong, private Consultants work with several private hospitals and all private hospitals knew that these are the geese that lay the golden eggs. All hospitals provide excellent facilities for them including free valet parking as time is precious.

Could this be why so few consultants are objecting to the changes? I remember one such Private Hospital in Sheffield where there is no charge for parking and there was even free Cappuccino!

What about the quality of work?

Remember, in England, NHS or Private, they are the same consultants.


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