Billions of pounds of health lies
The documents given to The Telegraph establish beyond reasonable doubt what all doctors working in British hospitals have long known but many have been afraid to say: that decisions affecting the treatment of patients are being made not on proper clinical grounds but merely to meet government targets that were themselves devised, and are now being used, to make crude party political propaganda.
This is not a marginal problem, and therefore unimportant: it goes to the very heart of the way our hospitals work. The moral and intellectual corruption wrought by Downing Street is now so deep-seated that it will take years to eradicate it.
Hospitals are complex organisms: they have to treat not only people who come to casualty departments but people with acne, constipation and all the thousand natural shocks that flesh is heir to. They are always delicate balancing acts. To set hospitals simple and arbitrary targets, therefore, such as that the waiting time in casualty should not exceed four hours, is to distort and corrupt their work completely. But if this means that patients have to suffer, so be it: just so long as Mr Blair can get a good soundbite out of it.
The email from Paula Friend, the "Director of Delivery" at the Royal Cornwall Hospitals, is by no means untypical. A very similar email was sent last week by the Chief Executive of the hospital in which I used to work. In her email, Ms Friend implies very strongly that doctors should discharge patients sooner than is wise or kind, not to meet a true medical emergency but a politico-bureaucratic one, namely the missing of a completely arbitrary government target. That this might entail discomfort or even danger for the patients hardly seems to matter. The chief executive of my former hospital suggested something very similar in his email, though slightly less baldly.
Several documents make perfectly clear what any student of the Soviet Union would have expected: that in a centrally organised system, the setting of targets results in vast bureaucratic efforts that result in nothing but lies and fraud.
Measures to keep waiting lists down - that is to say, statistical waiting lists, not real waiting lists composed of living, suffering human beings - include asking local general practitioners to delay referral to specialists.
The email from Mr Raphael, ''Director of Finance and Performance'' in East Cheshire, is an example. Another way of keeping waiting lists down is not to put patients on such lists until they have replied to a letter from the hospital telling them that they have been referred. Since a substantial number of people reply late, or not at all (some because they are too ill to do so), waiting lists are substantially reduced.
The efforts of the Epsom and St Helier Trust to meet the four-hour target would be comical if they were not nearly criminal. They are worthy of Gogol at his most surreal. At St Helier Hospital on January 24 2005, 13 members of staff, including three doctors, met for an hour in an ''Emergency Access Target Executive Debrief'' (does anyone actually think in such language?) At Epsom Hospital, the following day, there was another such meeting, also with 13 people present, of whom three were doctors. If one includes those who apologised for being absent, these meetings involved no fewer than 24 managers. The Department of Health wants such meetings to occur daily, and hospitals managers are now getting updates on how the casualty targets are met every two hours. Thus we see how it is possible to spend billions on the production of lies.
Methods to reduce waiting times in casualty include redesignating trolleys in corridors and elsewhere as hospital beds, shifting gynaecological patients from their ward into an antenatal ward so that casualty patients could be accommodated in the gynaecological ward, renaming observation areas as wards, dumping patients more or less unattended elsewhere in the hospital and, of course, discharging patients in the rest of the hospital too soon - a process I have now witnessed many times myself.
The situation is actually worse than this. The very process of diagnosis is being distorted and corrupted by the targeteering, and risks are being taken by doctors to avoid the admission of their patients to hospital. Not long ago, I saw a patient who had been sent away from a local hospital with completely inadequate treatment, though a medical qualification was not necessary to see that he was seriously ill. It is difficult to believe that such a gross error of medical judgment would have been made without the pressure of having to meet targets; and had he not subsequently been sent to prison, he might have died without proper medical attention.
The managers are both beneficiaries and victims of the whole iniquitous process. They are beneficiaries, because they are paid higher salaries than their talents might otherwise command in any but a corrupt bureaucratic system; but they are victims because they fear for their jobs to such an extent that they are prepared to carry out any order coming from on high. (The fact that, when sacked, they soon find a job elsewhere at a higher salary does not reduce their fear of dismissal.)
As for the doctors, with few exceptions, they also fear to speak out. One of the doctors who wrote an impassioned protest at what was happening asked not to be named, for fear that her outspokenness would result in the sack.
Since doctors are now in receipt of very considerable, and pensionable, bonus payments at the discretion of managers, which can also be withdrawn by the very same managers, they have been corrupted into silence. The evil is now seamless.
The chief executive of an NHS trust not a million miles from where I write this explained the lack of increase in the trust's budget this year by the lack of marginal seats in the area. The chief executive of another NHS trust, also not a million miles away, said that she spent 80 per cent of her time ensuring that the Labour government was re-elected. She didn't like it - but then her job depended on it.
With my retirement, I have left these problems behind me. I have achieved what most senior doctors in the NHS wish to do: retire as soon as possible.
This is not a marginal problem, and therefore unimportant: it goes to the very heart of the way our hospitals work. The moral and intellectual corruption wrought by Downing Street is now so deep-seated that it will take years to eradicate it.
Hospitals are complex organisms: they have to treat not only people who come to casualty departments but people with acne, constipation and all the thousand natural shocks that flesh is heir to. They are always delicate balancing acts. To set hospitals simple and arbitrary targets, therefore, such as that the waiting time in casualty should not exceed four hours, is to distort and corrupt their work completely. But if this means that patients have to suffer, so be it: just so long as Mr Blair can get a good soundbite out of it.
The email from Paula Friend, the "Director of Delivery" at the Royal Cornwall Hospitals, is by no means untypical. A very similar email was sent last week by the Chief Executive of the hospital in which I used to work. In her email, Ms Friend implies very strongly that doctors should discharge patients sooner than is wise or kind, not to meet a true medical emergency but a politico-bureaucratic one, namely the missing of a completely arbitrary government target. That this might entail discomfort or even danger for the patients hardly seems to matter. The chief executive of my former hospital suggested something very similar in his email, though slightly less baldly.
Several documents make perfectly clear what any student of the Soviet Union would have expected: that in a centrally organised system, the setting of targets results in vast bureaucratic efforts that result in nothing but lies and fraud.
Measures to keep waiting lists down - that is to say, statistical waiting lists, not real waiting lists composed of living, suffering human beings - include asking local general practitioners to delay referral to specialists.
The email from Mr Raphael, ''Director of Finance and Performance'' in East Cheshire, is an example. Another way of keeping waiting lists down is not to put patients on such lists until they have replied to a letter from the hospital telling them that they have been referred. Since a substantial number of people reply late, or not at all (some because they are too ill to do so), waiting lists are substantially reduced.
The efforts of the Epsom and St Helier Trust to meet the four-hour target would be comical if they were not nearly criminal. They are worthy of Gogol at his most surreal. At St Helier Hospital on January 24 2005, 13 members of staff, including three doctors, met for an hour in an ''Emergency Access Target Executive Debrief'' (does anyone actually think in such language?) At Epsom Hospital, the following day, there was another such meeting, also with 13 people present, of whom three were doctors. If one includes those who apologised for being absent, these meetings involved no fewer than 24 managers. The Department of Health wants such meetings to occur daily, and hospitals managers are now getting updates on how the casualty targets are met every two hours. Thus we see how it is possible to spend billions on the production of lies.
Methods to reduce waiting times in casualty include redesignating trolleys in corridors and elsewhere as hospital beds, shifting gynaecological patients from their ward into an antenatal ward so that casualty patients could be accommodated in the gynaecological ward, renaming observation areas as wards, dumping patients more or less unattended elsewhere in the hospital and, of course, discharging patients in the rest of the hospital too soon - a process I have now witnessed many times myself.
The situation is actually worse than this. The very process of diagnosis is being distorted and corrupted by the targeteering, and risks are being taken by doctors to avoid the admission of their patients to hospital. Not long ago, I saw a patient who had been sent away from a local hospital with completely inadequate treatment, though a medical qualification was not necessary to see that he was seriously ill. It is difficult to believe that such a gross error of medical judgment would have been made without the pressure of having to meet targets; and had he not subsequently been sent to prison, he might have died without proper medical attention.
The managers are both beneficiaries and victims of the whole iniquitous process. They are beneficiaries, because they are paid higher salaries than their talents might otherwise command in any but a corrupt bureaucratic system; but they are victims because they fear for their jobs to such an extent that they are prepared to carry out any order coming from on high. (The fact that, when sacked, they soon find a job elsewhere at a higher salary does not reduce their fear of dismissal.)
As for the doctors, with few exceptions, they also fear to speak out. One of the doctors who wrote an impassioned protest at what was happening asked not to be named, for fear that her outspokenness would result in the sack.
Since doctors are now in receipt of very considerable, and pensionable, bonus payments at the discretion of managers, which can also be withdrawn by the very same managers, they have been corrupted into silence. The evil is now seamless.
The chief executive of an NHS trust not a million miles from where I write this explained the lack of increase in the trust's budget this year by the lack of marginal seats in the area. The chief executive of another NHS trust, also not a million miles away, said that she spent 80 per cent of her time ensuring that the Labour government was re-elected. She didn't like it - but then her job depended on it.
With my retirement, I have left these problems behind me. I have achieved what most senior doctors in the NHS wish to do: retire as soon as possible.
http://news.telegraph.co.uk/news/main.jhtml;sessionid=VK2A1M2K1TR0DQFIQMFSM5OAVCBQ0JVC?xml=/news/2005/04/10/nhs310.xml&secureRefresh=true&_requestid=8107
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