Dr. No says, confusion amongst the proletariat as to what these changes may mean together with a touching belief that 'doctor knows best' so he/she would be the best one to trust to deliver that change.
He is of course correct; the patient at least until they come up against poor care, delays in treatment and being given into the care of the local ISTC, is unlikely to notice or care much about the changes. I can honestly say that until a few years ago I was much the same. Confident that all the cash I had handed over to NuLabour, had vastly improved the NHS because I had not had the need to call upon it. When I did however, horror of horrors I found it be peopled by, well ... idiots, who seemed to have been promoted well beyond their IQ and certainly their pay scale. Care or even interest, was missing. Drugs were handed out like sweeties for virtually no reason with no explanation of effect or prescribing reason. It seemed to be based on a 'just in case' protocol. Of tests there were many, but no results conveyed to the patient, (and probably to the Doctors), in fact the general status of the patient seemed to have a similarity to that of a mushroom; kept in the dark and doused (dosed?) with s**t, every day.That was the beginning of my antipathy toward the NHS and Doctors, which escalated with subsequent years of further mistreatment and lack of candour, culminating in an event of near death, that almost left me alone, and a legacy for one that I love, that continually intrudes into my life and thoughts.
For me then, the NHS was already 'not fit for purpose', long before Lansley's cynical escalation of the 'privatisation' model he learned form Kaiser, dressed up in the clothing of a 'Health and Social Care Bill' that escalates the NuLabour agenda of the NHS as a bounteous 'Facilities Manager', ordering Health care from a menu provided by Spire, Circle, Serco and all the plethora of Private Provision that expanded on Blairs 'watch'. I do not want it like this, any more than I want it to be as it is. But, a number of my friends as well as a good number of those I might call enemies, seem to feel that the reforms are so completely wrong, that they have to side with the NHS as it is, not as it should be. This model so out of step with need, with competence and any pretence of the provision of scientific treatments to promote health, now seems to be something we hold so dear that it has to be talked about with fiery rhetoric and a tearful eye. Even some of the architects of ISTC's, QOF and many other steps to Privatisation, such as the appalling Andy Burnham, the last Secretary for Health, have ranged themselves against Lansley's reforms purely for cynical political reasons. I am uncomfortable with him as a fellow traveller. Is the NHS so good that we should defend it with such passion, when before we did not, just because we don't like the new model? Well I think not.
So then, what has it achieved since the current model Circa 2004, has been in place, as regards one of it's foremost protocols, the Quality Outcomes Framework? A study from Finland shows that the actual cost and outcomes for osteoporosis are some way from the model upon which the protocol was based. And it is clear that the Randomised Control Trial bore no actual relationship to real clinical settings or the cohort for which they are prescribed. The outcome then for those who are taking a significantly awful medication was negligible. Equally as well, the study by Brian Serumaga of Nottingham University of the outcomes for hypertension in 470,000 individuals showed clearly that no discernable difference was found after the application of 'payment by results' for GP's, to reduce BP in the cohort than before. This was despite the payment of some £1.8 billion of taxpayers money to GP's!
We need to change the paradigm. Incentives for prevention have been expensive and counter productive and have actually been dangerous for a large number of people; the 'worried well' in particular. Most Doctors do not, and should not need incentives to enable them to perform. Those that do require payment, on top of an already generous salary and pension, to simply do their job, I would proffer, are not suited to the vocation. Any assumptions that Doctors are influenced by pay for motivation are flawed and should not be countenanced. The NHS is not a 'milch cow' for the unprincipled few who look to it for enrichment. These are those who continue to take the Clinical Excellence Awards, long after their achievement of any excellence was concluded, because once established there is no mechanism to end them.
The NHS is then perverse, corrupt and lacking in care, so change it we must. But the polemic employed by each camp is far too simplistic, should not the argument be better than this? And do not Doctors have have any responsibility for the appalling debacles that have occurred in the last few years, and indeed throughout history? I do not wish to share any platform of opposition with opportunists like Dr. David Owen who seems to think his No to AV stance will not close the door to electoral reform, when it patently will. We need progressive change, not another 'top down' Whitehall dictated revolution to empower cash hungry GP's and Private providers to even worse excesses than they have already perpetrated. We need no more PFI's and ISTC's because they deliver little other than profits for the shareholders. And we need to make Doctors answerable for their actions as a first priority. If we do that one thing maybe all the rest will fall into place.