I missed this essay from a much rspected elder when holiday.
Essay: The NHS in the age of anxiety: rhetoric and reality—an essay by Rudolf Klein. BMJ2013;347doi: http://dx.doi.org/10.1136/bmj.f5104(Published 21 August 2013)
Statistically there does not seem to be much wrong with the National Health Service. At the turn of the year, the Department of Health could report that “key performance standards” had been maintained even as fiscal austerity began to bite.1 Some, such as hospital infection rates, had even continued to improve. Further, the department expected the NHS to have passed the halfway mark towards achieving its £20bn (€23bn; $31bn) savings target by the end of the 2011-12 financial year.2 A more recent sample survey also suggests that there has been no deterioration in performance, bar a marginal increase in the number of patients waiting for more than four hours in emergency departments.3
Organisationally, too, the NHS seems to be a success story. It has successfully implemented the disruptive and distracting Lansley programme of change. This involved closing down 170 organisations, creating 240 new ones, making 10 000 staff redundant, and then re-employing 2200 of them.4 NHS England, as the NHS Commissioning Board has chosen to style itself, is now in charge of the service, churning out instructions, consultations, and exhortations at a manic rate. Yet it would be surprising if the public and patients noticed any difference in the way the NHS operates, so smoothly managed has been the transition; it is those working in the service who have absorbed the shocks and pain of change.
Bad news stories
But, of course, there is another story to be told: that of the NHS stumbling into crisis. The three volumes, 1781 pages, and 290 …
read the whole essay – Klein-bmj.f5104
The deterioration in performance in Wales, with waiting times twice as long as England is significant and serious. Hywel Dda Trust exclusion of Hip/Knees is rationing under any name. But the English NHS is also in trouble as choice is relatively inappropriate for common conditions, and unavailable for those with travel challenges. Klein avoids recommending rationing, which by itself would still not be enough. The 4 organisations have such high overheads in the form of administration, sickness and absence, and litigation etc. that although I hate the idea, I am more and more inclined to make each trust/hospital completely independent so that new cultures and organisations evolve. Some will go bust… and there will be a great deal of short term pain, but it should all be worth it if we can streamline the service and avoid the current “swimming in treacle” as Klein describes it, with morale sinking in many staff. Their career progress was often fossilised in the demise of “agenda for change” as the only defence for trusts became to renegotiate contracts, and get most people to do the same work at a lower grade,