SCP Chairman's annual address Last May Dr Andrew Butler asked in an open letter to a UK medical newspapernot the SMA NEWS - whether he was stupid in providing an out-of- hours (NHS) service for £3 an hour. A response letter from Mr Nicholas Wheer, a consultant maxillo-facial surgeon gave a blunt answer. Yes. He added that most people would not wake up for this, let alone get out of bed; he went on to condemn the shocking exploitation of doctors, of their ethics and social conscience, by the politicians and Whitehall DoH.
However, he reserved vitriol for the BMA , the doctors' trade union, for negotiating that derisory hourly rate. I'm not sure that it is sufficiently widely appreciated that the SMA remains.fonnally shackled to the concept of the NHS as a national health delivery policy. This is a hugely unwieldy organisation, the largest employer in Europe and said to be (is it a joke?) equalled only by the size of the Chinese army. So whenever any of the myriad problems thrown up by this now hugely cack-handed system are discussed, the elephant in the room is ignored. And to be fair many doctors, as you might expect since they grew up with the system, still defend it, despite its failures, its stars, its targets and associated inexorable subjugation of the role of doctors as it raises up the TEAM (while denying medical leadership), especially in psychiatry. The Society has endeavoured to focus minds on this in its response document NEW ROLES FOR PSYCHIA TRISTS.
The original NHS was a noble concept but so was food rationing during the war. Even that finally stopped in 1954. As a direct systems consequence over the past fifteen years or so the power to drive NHS health services forward was wrested from medical hands and placed in those of bureaucrats answerable to politicians rather than to patients.
This major flaw remains: despite the unwieldy hugeness of this national organization the political centre contrives, not only to facilitate broadbrush medical services, but to micro-manage it. This would be a well nigh impossible task if it were solely procuring and distributing nothing but oranges for the nation. For the task complexity of treating the individual health problems of every citizen in the land, it has all the subtly of attempting to manage a space programme with a kangol hammer as the sole device. This year's £73 billions spent in the NHS was a record, yet here are some of the more glaring anomalies.
Despite the plethora of 'Modernising Medicine', and 'Modernising Medical Careers' initiatives and quangos there remains an endless litany of politically engendered foot in mouth gaffs. The EWTD shambles and implications for medical training can at least be laid at Brussel's door. But the massive shortage of homegrown doctors 1E).ading to sometimes dubious imports completing their pre-registration year finding it impossible to get and SHO job, and many signing on for the dole or contemplating emigrating. One aspirant SHO found that for one such post there were 1,200 other applicants. Meanwhile, in that black-comedy fashion of flying in relatively untested foreign medical teams to prettify waiting lists, a French surgeon hired to treat NHS patients left nine of the fifteen patients treated with problems. The last straw was his consulting a surgical textbook during an operation. Theatre staff raised the alarm. How did he get GMC registration? Incidentally, this particular man was head of orthopaedic surgery at a hospital near Paris .
Remember Foundation Hospitals? Recent assessment is that their effect is neither here nor there (apart from all that jazz and upheaval) when compared to existing non-Foundation ones. Then were those new Independent Treatment Centres (ICTs); government has now decided it will after all allow NHS doctors to work in them, big deal. They couldn't be staffed otherwise.
It has been revealed that one third of NHS Trusts cannot afford to implement their (government's) own NICE (National Institute of Clinical Excellence) clinical guidelines because they (trusts) are in debt to the tune of 7 to 20percent of their budget. That figure increases as more Trusts admit more deficit. Incidentally, the unsatisfactory NICE guidelines on ECT were addressed by the Society and it was revealed to us by NICE's Chief Executive that at that time it had no psychiatrist as a member of NICE's standing advisory committee.
.. Family doctors are in the quandary of PBR (payment by results) and how to square the circle of competition and cooperation. Nevertheless, they have two huge advantages over all hospital doctors: they have retained', since 1948, self-employed status which can allow them more freedom to run their practices as they see fit. By contrast all hospital doctors are employees of the state: more easily pushed around by politicians. Secondly, they (family doctors) are therefore, and also, more effectively represented by the BMA. On the other hand, hospital doctors, and here we can mention seniors in particular, are not allowed at present to be directly represented by the Hospital Consultants and Specialists Association (HCSA) during negotiations with their employing authority. A grave disadvantage.
.Surgeons are up in arms about government driven SCPs (nothing to do with usl), non medically qualified 'surgical care practitioners': The Royal College of Physicians ditto about non-medically qualified physician assistants, and there is an initiative to involve clinical psychologists in the compulsory admission and other aspects of patient management, normally undertaken by consultant psychiatrists. Even psychologists are worried about this one. The Implications for patient care standards are enormous.
Last month it was revealed that the Oxfordshire Mental HeaJthcare Trust proposed that it will cut seven consultant posts by March next and reduce by 6 or 7 the number of SHO posts over the following twelve months
Add to these tasty morsels the sandal of doctors being suspended by hospitals, sometimes for years, on grounds that any trade union in Britain (other than the BMA) would have been seen off in days as a legitimate defence of its members. That shame has included ruined lives and doctors suicides. One David doctor, the SCP's Dr Peter Tomlin, through the Suspended Doctors Group, ably chaired by Dr Denis Murphy, has done more_in helping unjustified persecution of doctors than the Goliath BMA. We hope to hear more about that continuing activity from Peter later.
And the GMC with its 40% lay membership? Its decisions to acquit doctors accused of malpractice can now be overturned by the new Council for Healthcare and Regulatory Excellence, which can decide to refer the case to the High Court. This is recreating the timeless injustice of double jeopardy. Where is the BMA in all this? On the sidelines it seems: feebly reacting to government policy as practitioners mostly look on in bewilderment, a few older hands vaguely remembering when doctors significantly influenced and led the health service.
On 27 October 2005 Drs.net published an elegiac piece from a doctor titled The End of UK Psychiatry in which he observes that psychiatrists, as the most highly trained and informed practitioners, with responsibilities to match in the field of mental illness, are being sidelined in patient care decisions by other less informed, less trajned healthcare professionals. It is a thoughtful analysis that deserves to be read widely. We can but assert, as did Ernest Hemmingway, the sun also rises. |