Scalpel! This NHS red tape needs removing

On election day Health Direct quotes this cancer specialist- The internal market has been a costly disaster. Let the professionals manage medicine.
On election day- lets cut NHS red tape
It’s election time, and our glorious political classes are marching forward on the massed ranks of the electorate with banners that claim that their party, only their party, will save the NHS.

Politicians clamour to praise its world-class status and laud the dedication of nurses and the skill of its doctors. And all parties are united in the view that, despite the need for austerity measures, frontline staff and services will not be cut. So where are the savings planned? Watch the hand and not the mouth.

When I started in medicine, the hospital was run by about three people. Things were so much more simple when doctors and nurses treated patients, doing their best without the guidance of guidelines and targets, doing their best … yes … to make the patients better.

How did we manage without forms to fill and waiting times compliance? Quite well actually. The medical director ran the medical side of things while matron and the accountant handled the rest. It wasn’t much of a business then: it didn’t have to be, because there was no internal market to manage.

The internal market — Mrs Thatcher’s plan to introduce efficiency by having hospital compete against hospital to provide patient treatment — has wreaked havoc. It has spawned a nation of administrators, here today and gone to another post tomorrow — while doing nothing to bring costs under control.

The internal market’s billing system is not only costly and bureaucratic, the theory that underpins it is absurd. Why should a bill for the treatment of a patient go out to Oldham or Oxford, when it is not Oldham or Oxford that pays the bill — there is only one person that picks up the tab: the taxpayer, you and me.

And there are big problems with the billing process. For example, if a patient is seen in an outpatient clinic then there is a charge made by the hospital for his or her first attendance — but follow-up appointments are not charged. And if many treatments are given in a hospital to a patient, only the most expensive of the treatment episodes is charged.

There are savings to be made. It is alleged that there are just 75,000 administrators at work in the NHS but this figure is laughably mythological. Doctors and nurses know that there are many more than this. They look around and see the numbers increasing.

One report by the Centre for Policy Studies published in 2003 indicated that there were 250,000 administrative staff employed in the NHS: at least one administrator for every nurse. In recent times the rate of increase of admin staff within the NHS has exceeded that of nursing staff.

There is a general feeling in the NHS of disempowerment of the professionals. People can’t face up to the incredible struggle, the disapproval that faces any of them if they have the temerity to suggest that things should be run differently.

The principle of care for all from cradle to grave is worthy and wonderful. But the current reality is a cradle rocked by accountants who are incapable of even counting the number of times that they have rocked it. The reality is gravediggers working with a cost improvement shovel made of rust.

Over the years politicians have made dramatic changes to the way that the NHS has been run. Recent changes have caused fragmentation and not led to any cost saving. Moving patients from one place to another does not save the nation’s money, though it might save a local hospital some dosh. So the internal market has failed because it does not consider the health of the nation as a whole, merely the finances of a single hospital department, a local hospital or GP practice.

So what should we do? Let us go back to the old discipline of the NHS. Let the professionals manage medicine, empower the professionals, the doctors and nurses and shove the internal market in the bin and screw down the lid.

At this election time please let us hear from all political parties that they will ditch this absurd love-affair with the internal market. Instead let them help the NHS do what it does best — treat patients, and do so efficiently and economically without the crucifying expense and ridiculous parody of competition.

Professor Jonathan Waxman is a consultant oncologist

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