Sunday, 8 February 2015

A&E for GP Out of Hours.

Much has been said of the current state of the NHS in Scotland along with the usual political cant over A&E waiting times in Scotland which, while not meeting the Scottish Government standard, are still far superior to those in either NHS England or Wales.
The fundamental problem with the NHS across the UK is it has evolved a top down management system which is not fit for purpose, tied into political demands, lead routinely on very dubious evidence from those shouting the loudest in patient, professional or political lobbying circles, often for a narrow vested interest. Much of the current arguments for the decimation of the NHS in England are based on this narrow political, rather than any patient orientated, interest. The result of these NHS England political demands have repercussions which rebound on the NHS in Scotland historically, operationally and fiscally.
The SNP have de-linked political interference in NHS Scotland to some extent by undoing the previous Lib-Lab coalitions ‘internal market’ farce and PFI scam but there remains an instinctive insistence on top down ‘instruction’ which leads to NHS Scotland’s management’s skewing of actual patient needs and resources to be seen to have achieved these instructions. Throw in the inter departmental ‘games’ played within hospitals when budgets are being agreed and you have all the recipes for a dysfunctional NHS Scotland management where patients actual needs become secondary to personal egos, departmental budgets, influence and future promotion expectations.
It never seems credible to me while the medical professions in the NHS are expected to deliver patient care based on objective evidence and best practice, the funding for this care is often based on ‘political’ hubris, who shouts loudest and media driven hearsay all coupled to unreasonable expectations. Is it any wonder that staff within the NHS feel under excessive stress and while NHS Scotland is better funded than NHS England it still suffers from staff retention problems and high levels of sick days, both of which reflect low staff moral. In any organisation low staff moral is indicative of poor and unresponsive management.

The problems in A&E and GP out of hours care in Scotland are down to the mismanagement of highly dedicated health care professionals by both politicians and NHS management. The roots of this mismanagement lie in the continuing top down approach to resolving the unsustainable expectations placed on a Rolls Royce of a public service by an outmoded command economy style of NHS management, starting with the politicians. The way to resolve these and many other problems in NHS Scotland is by refocusing on the actual clinical need versus the funding available, rather than by the reliance on unsustainable political and public expectation. A good start will be to ask the ‘ordinary’ A&E staff or the local GP’s how to resolve the current problems, as they are more likely to have an effective solution than the vested interests in the Royal Colleges, Universities, BMA, RCN or NHS Management, all seeking to defend their empires.

It is time NHS Scotland sought to reform its management practices and culture both within its politics, administration and clinical delivery otherwise the same core problems which currently beset it will remain, to the continuing detriment of patient care. Throwing funding at a problem is not always the effective option. A start would be to identify patients’ core needs from NHS Scotland and seeking to address these first and always while more effectively managing unreasonable expectations.

You may expect to be seen by a GP on the same day but do you always need to?

1 comment:

  1. Just to pick up on your point regards the people actually working in the NHS, with patient care based standards and best practice, I always wondered why these standards do not appear to be applicable to those making major decisions for the people they are meant to represent, ie the politicians. What about people care, ie for the people who employ them, the tax payers, (we all pay tax, even if jobless as VAT is a tax) best practice as well as performance goals and if not met they should have to retrain and if that fails, out on their big fat selfish arses.