26 August 2008

The altruistic organisation

There is a wide belief amongst doctors that altruism is important to the concept of medical professionalism. There is also a view that new contracts introduced by the government for both consultants and GPs make delivering the altruistic element of medical practice more difficult. Dr Grumble is not sure that he agrees. But that is not the point of this post.

The point of this post arises from something Dr Grumble heard on the radio on his way to work. There was talk of the government's new ways of paying hospitals failing to cover the costs of some of the best work. A particular operation was the example. But this has always been the case for NHS hospitals. We have always robbed Peter to pay Paul. We have traditionally never said that we cannot do a particularly expensive but essential treatment because we will make a loss. That has not been the way. The NHS hospital is an altruistic organisation. It does its best to balance its books overall but it is happy to make a loss on some things. In the past, when it was essential, hospitals even used to make an overall loss. It was forced on them by clinical need. The price was paid to ensure that patients got the treatment they needed. The accountants had to sort it out later. That was altrusim.

Private organisations will not do that. Not to the same extent anyway. They might gain on a few swings and lose on some roundabouts but that's as far as it will go. But the altruism of the traditional NHS organisation is quickly being lost in the headlong rush for privatisation. How can you have an NHS organisation that is altruistic competing with a private organisation that is not? The NHS organisation will not be perceived as caring and altruistic but will be branded as ineffective and inefficient. And that, of course, is the reason why this got on the radio this morning. Because if we do not sort this out not only will the private organisation not give the loss making treatment but the NHS organisation won't be able to either.

Wouldn't it have been better if we had just kept the NHS altruistic organisations we used to have? What sort of government is mad enough to eradicate altruism from individual doctors and hospitals? Sadly, that government is ours.


Claire said...

I guess where they are in the USA now. I read this very sad post on a thyroid froum today. It makes me eternally grateful for thye NHS -and scared that this is how it will be here in the future too.

"i havent taken my thyroid meds for a long time. i was diagnosed with intermittent atrial fibrilations and flutters in feb. i thought maybe i had gone hyper but was never checked as my insurance ran out. they come and go constantly. 2 nights ago i went to the ER because my heart was racing and i couldnt breathe. my heartbeat never dropped below 100. i dont know what it was before that as i didnt get into a room right away and of course by the time i got in there it slowed down, but not under 100. 100 felt normal to me. i was supposed to go see a cardiac dr but with no ins its gonna cost 4k at least. my diabetes is way out whack, and im having a hard time controlling it. i also have blood and sugar in my urine."

Dr Grumble said...

The way we are heading frightens a great many of us. There seems to be no way to stop it. The politicians have their own private agenda. There is no public discussion about what they are doing to our NHS. No discussion at all. It's the main reason Dr G blogs.

What's happened to your blog, Claire? Nothing new for ages.

Claire said...

mmmmm....my blog..hangs head in shame...mostly work has got in the way. Teaching several days a week in local primary school and running a busy holiday cottage...and then there's the animals; the 2500 trees we have planted and the newly established orchard. Promise to try and get going again soon!

Anonymous said...

Hi Dr grumble

Is there ever such a thing as an Altruistic Organisation? I think that there may be people that sometimes display Altruistic behaviours and some more then others. The statistics for avoidable death rates under the current NHS system and the States are actually very similar and to be honest if I had to choose to die due to beurocratic incompatence or corporate greed - I'd rather go for the greed. Its a more honest emotion then all those altruistic people working in the current NHS feeling so good about helping people.

Dr Grumble said...

I see your point anonymous. The bottom line for all organisations is the money - even the church. But I think there was and still is a definite ethos amongst NHS managers that means that they see their role as first and foremost providing a much needed public service and certainly not to maximise profits.

If both ways of delivering a health service work there would be no argument. But with the fall of communism and the obvious failures of that approach it is uphill even suggesting that there are two ways to skin a cat and that the currently least preferred one might actually be better.

You must be American. Every man for himself and there's nothing wrong with just being out to make money. That is the received wisdom over there. Those sentiments are gaining hold here. Frankly I don't like it. People do do things other than for money. Even in America. But that's not to say that money is not important as a driver to make things work better.

Anonymous said...

Actually Dr Grumble I'm a South African living in London and not American at all.

I think that we have to work with human nature rather than against it - and human nature is every man for himself and his extended family - thats why there's that saying "Charity begins at home".And then whatever you have left over you can choose to help others.

The point of charities and governmental organisations is to maximise efficiency. They also have a bottom line and that is to do as much as possible with their budget. Do you see NHS Managers doing that because I don't and unless they are doing everything in their power to do more for people with the money available they are not really helping anybody except themsleves. Thats what I'm talking about.