Religious sheep take control of NHS

Dr Grumble has been wondering about the sanity of those planning the latest health service initiative: swingeing bed cuts. There seems to be a new belief amongst NHS managers that hospital doctors are admitting patients who could be managed by their GP at home. This is one of those quirky managerial beliefs that has recently become propagated from somewhere on high. Who starts these concepts Dr Grumble has no idea. They arrive seemingly from nowhere and all of a sudden NHS managers throughout the realm slavishly follow the latest edict like flocks of mindless sheep. Whatever the idea is, however batty, the NHS manager will believe it implicitly and without question. Evidence-based management is not in the health service lexicon.

The approach has something akin to a religion. NHS management has much more to do with blind faith than reason. Consequently today's unquestioned mantra is that hospital beds need to be cut and that patients can be managed 'closer to home'. To be fair, there are certainly patients in hospital who should not be there. Most of them needed to be there when they were ill but then cannot go home because they can no longer manage without more social support. But getting that social support promptly can be, to say the least, a challenge.

Dr Grumble's ward round today was a long affair. Five whole hours without a break. He saw all sorts of patients. Some were in their teens. Most were elderly. Some were very rich. Most were quite poor. Some were very ill. Some were not so ill. One was not acutely ill at all. He was an elderly man who lives alone. He struggles to manage. He has some medical problems including long-standing ulcers on his legs. The nurses who look after him phoned the patient's GP yesterday and said that he needed to go into hospital. Yesterday was Friday. Things can seem worse on a Friday.

The GP did not go and see the patient. Perhaps he should have. On the other hand, quite possibly it was not going to change the outcome. If the nurses were not happy that the patient could be looked after at home what was the GP to do? Certainly the GP was acquainted with the patient and knew the situation. And, rightly or wrongly, he sent the patient in. The patient was dutifully clerked by a junior doctor and the patient was admitted to the Grumble ward. The patient was presented to Dr Grumble. Dr Grumble assumed that the ulcers on the ankles must be pretty grim and that that was the reason for the patient's admission. But when Dr Grumble saw the patient he was quite well and the ulcers were clean. There was nothing the hospital could do to make this patient any better. The patient did not want to be in hospital and was keen to go home. But because he is so old and generally frail he really cannot manage at home. Hospitals are open all day and all night and take all comers. There is nowhere else for these people. It has been like this for ever. And our managers have done nothing about it.