Let doctors fix the NHS

November 16, 2006

Clinician led management can fix the NHS, argues a senior doctor in this week's BMJ. He calls on the government to let clinicians and managers plan and run their services free from political control.

Senior medical professionals are often branded as opponents of reform, writes David Flook, Consultant General Surgeon at the Royal Oldham Hospital. But most medical personnel support changes, they just oppose "the cynical, superficial reforms through which politicians have exploited the NHS."

For instance, he condemns the "fraudulent claims" by health ministers that initiatives such as the "two week wait rule" have contributed to the recent modest fall in cancer deaths, and argues that fast track referral prioritises the worried well at the expense of the target population.

And he questions how patients can make a meaningful "choice" of who treats them from the vast NHS array. Was not personal referral to consultants by a GP preferable to the current lottery?

Other examples of subtle misinformation abound, he writes. The reduction in accident and emergency waiting times achieved by one recent initiative is hailed as evidence of improved performance. But this overlooks the sometimes dangerous means by which this goal was achieved, such as the premature transfer of acutely ill patients to almost anywhere outside A&E.

For strategic planners, the evidence suggests that they recognise the problem but choose to cut corners in service provision and avoid any political upsets, he says. And the problem for NHS managers is that politicians have replaced doctors in priority setting. "Managers are now no more than foot soldiers implementing the latest vote-winning initiative and I have seen no evidence that management consultants do better at even greater costs," he writes.

Even good managers can only make the NHS safe and fair, if freed from political control and willing to prioritise in accordance with guidance from the staff who treat the patients, he concludes.


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