29 August 2008

Not for managers

It looks as if Dr Grumble might have a few more readers from the Health Service Journal. Assuming, of course, that they have time away from their lavish parties. The NHS is becoming more and more like Big Business every day.

Anyway, in celebration of these important new readers Dr Grumble is going to reproduce the article he wrote for
R-UK Magazine. It wasn't meant for managers who know exactly what is going on. But here it is anyway:

Open your eyes

In case you don’t know Dr Grumble is a blogger. He likes to call himself a top medical blogger. It’s not really true but you can call yourself what you like on your blog. How many of you read medical blogs? Dr Grumble is addicted to them. He reads them avidly. The bloggers are often ahead of the game. Some of you may remember Dr Grumble frantically trying to alert the world to the impending catastrophe of MMC/MTAS. For a while nobody listened. Dr Grumble was incredulous as he watched the disaster unfold. Others knew there were problems ahead. But nobody did anything. All Dr Grumble could do was blog about it and try to alert everybody. It did no good. But it was a safety valve. Dr Grumble was able to vent his wrath. Eventually the house of cards collapsed and the issue hit newspaper headlines. But the bloggers were first. By a long way.

You won’t find Dr Grumble commenting much now on MMC/MTAS. The problem has been recognised. The great and the good are now on the case and sensible people have been empowered to try and sort it all out. It’s time for Dr Grumble to alert you to something that you may not be aware of. More mistakes are on their way. Human beings, you see, make wrong decisions. It happens all the time. It has happened throughout history. Why it happens is perplexing. Especially when the decisions are obviously wrong.

It’s a curious thing that the older you get the more history matters to you. After you have lived 50 years, a century doesn’t seem that long. And, curiously, when you can see the past it enables you to see the future. Another odd thing is that as the sands run out and your own future shortens you become more interested in what lies ahead. Yet the future matters most to the young. So why aren’t they concerned about it? Well, if the future is close they are. Remedy itself is testament to that. But anything much further ahead may be of less concern. For the young it’s too distant. It seems irrelevant. You don’t worry about your pension on your first day at work.

So what does Dr Grumble see in the future as far as UK medicine is concerned? The answer is privatisation. Many in medicine can see this happening though, curiously, not all. The writing is on the wall as far as the NHS as we know it is concerned. It’s happening in a strange piecemeal fashion. There’s been no public discussion about it. It’s just happening. There’s no overt policy on it. But clear signals are being sent out. Where did this policy come from? Who made it? And why? Dr Grumble has no idea. None whatsoever. If anybody out there knows please tell us all.

The early morning news is on as Dr Grumble writes this. It seems the media are catching up. Because one of the main news items is about outsourcing. There’s been some committee advising the government on this. And who do you think was on the committee? You can guess. It was full of the representatives of Big Business. These are the people who make money from outsourcing. So what do you think the committee has recommended? Dr Grumble will leave you to guess.

Outsourcing of public services has doubled in not much more than a decade. The value of the business is now close to £80 billion. That’s a lot of money. Somebody is making lots of money. That somebody is in favour of outsourcing. That somebody is advising government. Who is losing from this? If money is going to profiteers, is anybody losing? Perhaps. Perhaps not. It depends. What upsets Dr Grumble is that he sees no debate. No discussion on the pros and cons. He doesn’t think the government wants discussion. The government mind is made up. They ask advice from people who give the answer they want. Clever that.

What has all this got to do with the NHS? The outsourcing market now employs as many people as the NHS. In another decade, if outsourcing doubles again, will the NHS as we know it be gone? There are those that think that is exactly what lies ahead. Does it matter? Perhaps. Perhaps not. Are we debating the pro and cons of this covert policy? No. We can’t. Because the policy is not explicit. There are still a few of Dr Grumble’s colleagues who cannot see what is happening. And his younger colleagues are the worst of all. Yet for them it will matter most. Remedy has woken up to the immediate future. Remedy and its youthful membership now need to wake up to the more distant future. Ten years is not far ahead. It will matter to you. Dr Grumble will be out to grass.


Jobbing Doctor said...

Goodness me, these really are lavish parties. I wonder who pays from them, and from which budget?

Could this be the private sector trying to ingratiate themselves with Health Service Managers?

I think we should be told.

Dr Grumble said...

Jobbing Doctor, you have interpreted the purpose of this juxtaposition correctly. These lavish parties are plainly connected with the headlong rush to privatisation. But we won't be told. We won't be told because the public might not like what is happening to their NHS. Those in charge know that what they are doing is right so why not just get on with it with no discussion whatsoever with those who work in the NHS, those who use it or those who pay for it? That's the level of democracy we have in Britain today.

Dr Ewald Proll said...

Dear Dr Grumble, your description of politics and business affairs is very similiar to (if not identical with) the observations we make in Germany, exactly on the same level of democracy.

Huge change of social security systems, with a huge pressure towards privatization, are mediated by those who profit from privatization. And no sufficient public discussion so far.

We're trying to alter this, though. There will be elections next year, and we (doctors) are pushing into the media to trigger a more intense discussion.

By the way, the phenomena you decribe sure hit us (doctors and patients) worldwide. So I guess it might be worth a try, to coordinate the activities of citical minds, to achieve an efficient way of communicating. How about "Doctors of the wortld - unite!"?

Have a nice day, anyway.

Dr Grumble said...

Das finde ich sehr interessant. Doctors of the world unite ist genau was wir brauchen.

Dr Grumble is not at all surprised to learn that there are similar problems in Germany. Managerial thinking is very rigid and they all copy each other wherever they are in the global village. They are unable to grasp the possibility that they might actually be wrong.

To stop all this nonsense it probably will require us all to unite. It's beyond the power of Dr Grumble but perhaps the relevant medical organisations across Europe should get together and lobby for a more sensible approach.

Dr Ewald Proll said...

I'm in doubt that medical organisations will be of any help. Mostly they seem to be part of the establishment already.

We'll have to do it grass-root style, I guess. You're in?