Constructive deconstruction – of the ischaemic bowel in the UK Health Systems.. Politicians need a duty of candour like Mr Smallwoood

There is a condition called ischaemic colitis (IC) which presents with blood in the stool. It is easily mistaken for more common conditions such as dysentery (if acute), crohn’s disease and ulcerative colitis. Rumour has it that deep in the bowels of the department of health at “Elephant and Castle” is a paper ready for the moment when reality hits the politicians…. Diagnosis of IC, is not possible without much intrusion and investigation, and is sometimes one of exclusion.. Treatment is excising the failing bowel segment early..

A recent BMA Wales meeting was emphatic on the need for an honest language about the current state of the Health Services, and of the possible solutions. There should be the same duty of candour for politicians as for doctors. Whilst there is no pretence of “choice” in many regions, there is no use in choice as a virtue unless there is oversupply and overcapacity. In other words choice is a luxury for the richer expanding economies, and not for one with annual deficits. In order to cut our cloth to suit, we need to feel that we as a profession can give honest feedback to the politicians. Giving honest feedback is part of a trainers duty to his trainee, but he needs to avoid the pitfalls of demotivating his charge, (giving constructive feedback) so it should not be too hard for our leaders to be honest. Whilst there are a number of lesser issues, and operative adjustments that could make our health services more efficient, we have to realise that the future is one of managed decline – unless we deconstruct constructively. As the crisis deepens the temptation for a knee-jerk and destructive response may become too great…. Rather than cutting out the part that does not work in time, as in IC, we may leave it too late. Then the whole system collapses, septic shock and death is inevitable.. After consideration, the Minister and the Department need deep and intrusive internal investigation, rather than Beveridge’s solution..  Otherwise its a cold bath for all of us.. At least Mr Smallwood has spoken out (without using the “R”ationing word). We are witnesses to the ischaemic bowel disease present in the UK Health Systems.

Other countries are facing the same demographic changes and demands. Whilst birth rates fall, older people with multiple morbidities are living longer. Germany has encouraged immigration and refugees, China has relaxed it’s “one child” policy, Israel and Australia focus on individual responsibility (autonomy) at the expense of some social solidarity. In terms of pure cost (but not integration and care) Ireland and Singapore do well. Most countries with 5 year plebiscites have trained too few professionals: hence these professionals move to the system which treats them best.

A new book by Mark Britnell “In search of the perfect health system”, (published by Macmillan Education and Palgrave ISBN 978-1-137-49661-4) is going to be reviewed shortly, and will become essential reading for planners and strategists in the UK health services. This book analyses the strengths and weaknesses of 25 different universal national health care systems, and comes out with a list of best practices:

Values and universal healthcare of the UK
Primary care of Israel
Community services of Brazil
Mental health and wellbeing of Australia
Health promotion of the Nordic countries
Patient and community empowerment in parts of Africa
Research and development of the US
Innovation, speed and flair of India
Information, communications and technology of Singapore
Choice of France
Funding of Switzerland
Aged care of Japan

Whilst allowing for these qualities, politicians need to address value for money, cost effectiveness, encouragement of self care, and social solidarity. (Émile Durkheim -1858–1917). Any system to replace the UK Health Services will need to be sustainable, and by pragmatically encouraging of self-care, and accept that there is a little loss of liberty (and choice) in order to ensure that “fear” of inequitable care does not happen.

As Health and Social Care come under the same budgets, this “satisficing” of the system will become more evident. Two tier models such as Germany and Holland discourage social cohesion and solidarity. Universal systems without any co-payments encourage dependency – exactly what Beveridge was afraid of in his 1948 report.

What would a 2014 Beveridge report say?

Beveridge’s Bequest – Welfare reform is painfully slow, but it is vitally important

The politicians need to take a cold bath – just like Beveridge

Public ‘ignorant of NHS costs’ – why not?

A new philosophy, what I believe: allow Trust Board members to use the language of rationing in media press releases

NHS Litigation Authority – Duty of Candour guide (pdf) – applies to trusts and their staff, but not to politicians. Should it apply to strategists?

As chair of a trust, I’m speaking out. The NHS is headed for financial ruin – Christopher Smallwood in The Guardian 9th November 2015. “..more of the people who understand what is happening from inside the health system need to speak out. With a few honourable exceptions, they are reluctant to do so, which is understandable for professionals whose careers are at stake. But chairs and boards can, and must, do so.”

Rachel Millard reports in The Brighton/Sussex Evening Argus 18th October 2015: A&E consultants warns ‘NHS in peril’



This entry was posted in A Personal View, Consultants, General Practitioners, NHS managers, Post Code Lottery, Professionals, Rationing, 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.

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