Rurality and Utilitarian decision making: Wales is let down by its inept politicians.

No person in a rural area would suggest open heart surgery was done in their District General Hospital. The introduction of any new service has to be thought through, as it is very difficult to withdraw it, and “exit strategies” for new services are not usually incorporated in the planning…. Following the financial crisis, services are being centralised, and cut locally all around the country. Deaneries, those in charge of training standards for doctors, insist that there are “centres of excellence” and don’t allow “decentralisation” in the way second and third world countries manage their systems. In addition, the training of Generalists is not independent of the specialities, and the Royal Colleges often hold the whip hand over the Deaneries. Tribalism (see Jennifer Weller’s book)  is the rule… (‘There are no winners while there is ‘them and us’ tribalism in the NHS’ – 7 March, 2011 By Paul Zollinger-Read In the Health Service Journal). In addition, tribes such as the people of Pembrokeshire do not think in a utilitarian way for the whole of the Hywel Dda area. The same is true of Cardiff Bay.. but Tom Bodden is right when he says: “NHS is key battle ground  in England and Wales” (Daily Post, October 2nd 2013)

Occasionally a Politician recants and reverses when there is sufficient bottom up non tribal pressure. This is the case for Jeremy Hunt, who “backs down over voluntary help for hospitals” (The Times: Jill Sherman, Friday December 6th 2013) Would the media be kind on someone who tells the pragmatic truth? I doubt it.

Withybush Hospital is one of many peripheral and rural District General Hospitals (D.G.H.s) in the headlights in the country, and locally in the Western Telegraph, which has numerous news items. Public meetings expressing anger and concern have occurred at which Counsellors and GPs have been notably absent. Save Withybush Action Team (SWAT) is asking for a judicial review, and judging from the Lewisham Hospital case they may win. Lewisham is of course a city hospital and there are more than 3 others within 5 miles….

One of the problems is the way public meetings are chaired. I was present at a meeting several years ago and it was immediately high-jacked by political statements from local counsellors, and by employees of the local hospital who obviously had a vested interest. The chair did not find out how many people present were NOT politicians or health employees. He did not enquire if there were any people present who were prepared to speak for the local Trust proposed changes, and he lost control of the meeting. Within 5 minutes it became a succession of slanging outcries against the Trust, and I left, as if I had spoken out I feared I would be lynched! No person who spoke had a utilitarian approach with the whole of the people of West Wales in mind. They all had local interest at heart, but had failed to appreciate the financial imperative to stay within our means and to make the best of what we have. As it stands now, the change proposed at the meeting I walked out of, a new hospital in West Wales, is not on the table any longer, the money being spent elsewhere. But if it was offered now it would be grasped with open arms: what is proposed is worse by far! GPs in Pembrokeshire have written a letter to Trevor Purt, the C.E.O of Hywel Dda Trust to express their concerns about the current situation. Their letter is still private but I will publish here when it is eventually released. Although the desire to move services out of hospital has been present for some time, the levers to make the moves, including redundancies, financial flow changes etc have not followed the words.  (They are still held by the Welsh Assembly) A primary Care Led Health Service could be a great improvement on a Secondary Care led one, and the model is there in many of the world’s towns. However, none of these models has “Everything for Everyone for Ever”, and all depend on completely different philosophy and financial flows (E.g: USA). If I was a GP in a rural area now I would be enthused by the prospect of taking back many of the services

Another problem is that there has been no joined up thinking, and as a result poor use of resources (when they were available) to provide good transport links. The Welsh Assembly must take the blame for this.. and business leaders are not impressed.

Another problem is finance. The Trusts in Wales are all “bust” and going to run at a deficit again. If they were not government-funded the receiver would be called in. Further service cuts are inevitable..

All politicians have an interest in the near future: the next election. Getting them to think beyond and in philosophical terms is proving very difficult. Some won’t even speak, on direct invitation, on NHSreality. A second House elected on a Proportional Representative basis (instead of the House of Lords) and over 7 years might help. Having say 100 members only would help utilitarian decision-making. Giving an already inefficient Welsh Assembly more  tax raising powers is not the answer.

When I began NHSreality I predicted the resignation of many CEOs, Chairs and Trust Board members. The meeting of financial as well as service standards is impossible within the rules of the game. (Simon, H. A. (1963). Economics and psychology. In S. Koch (Ed. as summarised  by Rouslan Koumakhov in the Journal of Economic Psychology 1 February 2009). I predicted service and care scandals. The resignations have been evident since March when NHSreality began. There will be more resignations and more scandals…. and none of us, the public, will hear exit interviews unless they are submitted to NHSreality.. Should Hywel Dda join Swansea so its patients get access to tertiary care?

Please pass on this link, and suggest to board members, nurses, doctors and other NHS employees that they interviews to NHSreality… Meanwhile it will become more inconvenient for many who have to travel, but the results are what matter, and these should be as good. They could be better if tribalism is replaced with pragmatism, and the opportunity in the inevitable changes is seen instead of the threats. If I was a rural GP I would be excited.. but I still prefer my heart surgery in Swansea or Cardiff to Pembrokeshire.

From other health care systems:

Alberta cuts

USA – employer provided Health Care and The US system

Russian Health Care

and in Britain

Mental Health Services in the UK: Hospital or Community

Psychology: A study of a science (Vol. 6, pp. 685–723). New York: McGraw Hill.

This entry was posted in A Personal View, General Practitioners, Stories in the Media, Trust Board Directors on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

2 thoughts on “Rurality and Utilitarian decision making: Wales is let down by its inept politicians.

  1. Pingback: Strokes: Women sufferers ‘have poorer life quality than men’ | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

  2. Pingback: Doctors form new pressure group to prevent “marketisation” of NHS – Rationing by chaos | NHS reality. An NHS soapbox. Speakers' corner for the NHS.

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