A perverse incentive epidemic, especially in mental health – both for GP’s pay/workload in UK and increased organ donors in the US, or dying, means that the systems are likely to get worse ..

Evidence from the US tells us that there is a perverse incentive not to fund mental health – increased organ donors! We have to remember that patients with or without capacity have still got an obligation of confidentiality which continues after death. it can only be “broken” if it is in the best interest of the patient. The message is to discuss and work out the perverse incentives before implementing any change..


Amanda Hopchurch from New York reports in the Guardian 1st May 2016: Drug overdose epidemic has driven increase in organ donors, data shows

Damage of one public health crisis has prompted improvement in another: in 2015, 9.34% of organ donors died from overdoses, up from 1.1% in 2000

Tracy McVeigh reports 30th April 20016 in The Guardian: Vulnerable people regularly refused access to GPs, says charity

Refusals often due to lack of ID or proof of address even though none is needed, according to Doctors of the World

Dennis Campbell reports: Nearly three-quarters of Britons expect rapid decline in NHS, says poll

With 72% believing services will get worse, survey finds British public most pessimistic in Europe over future of healthcare

Almost three out of four Britons fear that the NHS will decline in the next few years, according to new poll findings that dramatically illustrate a growing pessimism about the health service’s future.

Overall, 72% of voters across the UK believe services to patients, already under unprecedented pressure, are set to worsen, despite government pledges of extra cash and improved care.

The polling firm Populus, which conducted the survey, says that is the highest level of pessimism among citizens in any of the six European countries in which it examined opinion.

Populus asked if participants agreed or disagreed with the statement “I am fearful that health services will deteriorate in the future”. In the UK 72% of the just over 1,000 respondents agreed, just ahead of Italy, where 71% of the same number of people held that viewpoint. Only half of Spaniards and Poles said the same. Just one in 10 Britons (11%) did not fear a decline.

“These stark figures show that, of all countries in Europe, we’re the most fearful for the future of healthcare, despite the government’s promise to protect the NHS budget. With news about lengthening waiting times, restrictions to new drugs and the junior doctors’ strike, our pessimism is perhaps unsurprising,” said Mike Birtwistle, a partner at the health lobbyists Incisive Health, which commissioned the survey.

The gloom revealed in the research should concern the government, he added. “With the King’s Fund concluding recently that public satisfaction in the NHS is dwindling, and these new figures showing the fear we have for the future, ministers might have good cause to be worried.”

The perverse incentives apply to the “new” performance indicator of “Do not resuscitate” bought in by overzealous top-down management without professional engagement  – the result is in the Times ( Kevin Rawlinson: Families are left in the dark as doctors let thousands die) and the Penarth Times

This entry was posted in A Personal View, Perverse Incentives 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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