The Editorial in the Lancet this week upbraids both Politicians and Doctors (mainly GP's) for failing to address Healthcare inequalities. It's is not very kind to Health Officials, and targets the Permanent Secretary particularly. In less than edifying language Margaret Hodge, was scathing about the failure to deliver the promise of NuLabour to remove these inequalities, despite the vast increase in the NHS budget and thirteen years of power.
The editorial was particularly strong in it's condemnation of the Profession and GP's in particular, for the vast rewards they have reaped, since 2005, when they took on the new contract. This saw income rise to an average of £105k, with some making £250k, by virtue of the bonuses paid for the achievement of goals within the Quality Outcomes Framework (QOF). These were mainly politically motivated objectives, that saw routine Healthcare reduced to a target culture, whereby GP's could derive payments for taking and recording things like blood pressure, or BMI, for certain patient cohorts. Worst of course, was the need to attain certain levels within QOF to reap a reward, which heralded the 'lipid' testing of perfectly healthy people, and the subsequent dosing of them with statins, or antihypertensives (whether they needed it or not).
Substantively, I agree with the sentiment of the Lancet article, although some of the detail is a bit 'overblown'. After all, some the GP's, who stand accused of indifference to their patients plight, may just have been exercising some scientific 'triage' of the goals set by various QOF's, and found them wanting of evidence of efficacy, and simply ignored them. Well more power to them, but why don't they stand up and be counted? As for Hodge, well she has an appalling record, in voting for all the Blair reforms in Healthcare, including the setting up of Foundation Trusts, yet she has obviously now 'seen the light' and wishes to align with the patient. The report is here.
When the 'blessed' Tony came to power in 1997, he was in a unique position. The majority of the country saw him as a reformer, with an evangelistic zeal, to drag Healthcare and Education into a new dawn, with reforms that were purported to be based on scientific agenda, not the thinly disguised and hugely expensive, 'privatisation' of these core needs of the populace. Instead, he failed to carry through his promises but gave us the 'spin' of his continuation of the previous lot's desire to sell off the assets we all owned, for a handful of beads and a sack of corn. Neo-Thatcherite to the core, he embraced private sector solutions to the urgency of improving Health (and Education) that were hugely expensive, and with it spawned legions of highly paid management cadres, who sucked up most of the money, building 'empires' to justify their ludicrous elevation within Healthcare.
He fostered many of the 'Quangos' that the ConDems are now pulling apart, on the premise that Governance was all about measuring process, at the expense of outcomes. The disenchanted Doctors, many of whom hated the rhetoric, failed to champion their patients and saw the chance to better their position by negotiating a new deal that placed them as financial equals to the Consultant cohort. Some at the time (2005) could not believe that they escaped from out of hours cover, for a paltry 6%. One of the senior negotiators for the BMA, even said he thought they were "having a a laugh". And, of course they were, all the way to the Bank! This single act alone hugely increased costs, but more; the outcome of QOF was to elevate costs even more, as the tests to prove it's effect spiralled.
So, money was spent that achieved little of any substance, other than the enrichment of most within the NHS, except the 'coal face' workers, who found themselves more and more, isolated from the patients they were there to serve. Management found ways to cut costs, that deprived patients of standards of care enshrined in that contract we all have with those we pay to help us when we need it. Emerging from this, large numbers of complaints began to arise, that then gave birth to a whole new Bureaucracy, given the task of 'managing' these. Not, I must add resolving them, because that does not seem to have been the objective. Obfuscation, delay, and even lies, were then employed, to prevent the delivery of truth, justice or candour.
Well, that was then, and this is now. The Coalition has suggested, even promised to change, all that has gone before. But Neo-Thatcherism is not dead, and now lives on in all politicians, with little to separate any from all. Practice Based Commissioning was already being rolled out by Brown's lot, before he lost the election. Calling it GP Commissioning does not change it, although at least it was not wholesale, it was a slow 'rollout'. Wholesale change, may be a good thing, although trying to cut a ludicrous 20% in the process is both unrealistic and unattainable. It will be just the same as before; figures will be produced to prove it's happening, that some Select Committee in five or ten years time, will tell us were untrue. Some very good people will lose their jobs and evidence based Healthcare will continue as before, without any evidence to back it's ludicrous policies. We'll all get fatter, get Diabetes, Heart Disease and Cancer and interventions to allegedly reduce the incidence will fail, just as they have for the last thirty years. The good Doctors will retire early, the bad one's will become leading lights in GP commissioning. Everything will be different, but stay the same.
Oh, and patients; you thought you had been screwed already, now you're really going to be f****d.