tag:blogger.com,1999:blog-25200961.post3054606279496818140..comments2024-03-26T07:19:50.901+00:00Comments on Dr Grumble: A pause for thoughtDr Grumblehttp://www.blogger.com/profile/04417731064007601504noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-25200961.post-2697928340103645962008-08-09T10:24:00.000+01:002008-08-09T10:24:00.000+01:00Mrs Grumble had the same concerns. Dr Grumble was ...Mrs Grumble had the same concerns. Dr Grumble was oblivious to the politics of the author (which are not apparent in the book).Dr Grumblehttps://www.blogger.com/profile/04417731064007601504noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-34093441198369470432008-08-05T12:26:00.000+01:002008-08-05T12:26:00.000+01:00Dear Grumble,I have returned, and on the basis of ...Dear Grumble,<BR/><BR/>I have returned, and on the basis of your recommendation and as part of my increasing conspiracy theory mentality, this old socialist has ordered a book by Peter Oborne (a man who I would not normally give shelf-space to).<BR/><BR/>I hope that it will be a stimulating read.<BR/><BR/>JD.Jobbing Doctorhttps://www.blogger.com/profile/15556376882759955757noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-47585997220737630862008-08-02T14:34:00.000+01:002008-08-02T14:34:00.000+01:00I woke up today to find that my blog 'undeleted it...I woke up today to find that my blog 'undeleted itself!'<BR/><BR/>Amazing stuff!!<BR/><BR/>But then, this IS the story of my life!<BR/><BR/>:)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-51817712416961662312008-08-01T08:41:00.000+01:002008-08-01T08:41:00.000+01:00This comment has been removed by a blog administrator.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-22963191835737251252008-08-01T08:29:00.000+01:002008-08-01T08:29:00.000+01:00This comment has been removed by a blog administrator.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-69762858341297359462008-08-01T07:06:00.000+01:002008-08-01T07:06:00.000+01:00if you have a small business, say your own private...if you have a small business, say your own private rooms in Harley Street, then you decided to borrow a relatively large amount of money to just do it up when you know the business will not pay back, then you are delibrately shacking your business with the intention of going bust. <BR/>*********<BR/>These rules may work in Harley Street when you are milking the insured and those with money but the real problem with health care worldwide is that it does not really generate wealth. This was the rotten thinking that goes back to the very inception of the NHS. They thought that if you spent money looking after the sick there would be a pay back. There is some truth in this but mostly we are keeping people alive to spend their pensions or reach the old folks home. <BR/><BR/>That is one reason why health care is so very different from other enterprises.<BR/><BR/>The NHS is a big yoke round the neck of any government. That's why they want to get rid of it in so far as they can. As for payback they need political payback which requires them to talk up the NHS. But in fact they often knock it - especially the GPs most patients love.<BR/><BR/>There is no reason to think any other party would take a very different line with the NHS. <BR/><BR/>There are some changes empowering local managers in Foundation Trusts which may bear some fruit. Who know? But don't think it is all bad. There are some jewels in the NHS with some very hard working people.Dr Grumblehttps://www.blogger.com/profile/04417731064007601504noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-29043936806961817652008-07-31T23:14:00.000+01:002008-07-31T23:14:00.000+01:00No need for the horse to talk Dr G :), if you have...No need for the horse to talk Dr G :), if you have a small business, say your own private rooms in Harley Street, then you decided to borrow a relatively large amount of money to just do it up when you know the business will not pay back, then you are delibrately shacking your business with the intention of going bust. That's exactly what the previous government did, then waited till the point of no tryutn before handing over to the new guys. They are honest and they are trying but to the people, it looks as if they are the ones who are failing! <BR/><BR/>And, your post is right, any new government will not be any different, I am beginning to think 'better the devils we know.'<BR/><BR/>And, if I were boss, I would do something you suggested a long time ago, turn the majority of the NHS into a co-operative. However, it seems the situation has even passed this point.<BR/><BR/>RegardsAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-18659970636174280012008-07-31T21:13:00.000+01:002008-07-31T21:13:00.000+01:00Necessary painful fixes would include hospital clo...Necessary painful fixes would include hospital closures. Dr G has lost count of the number of places where he has worked where there have been two acute hospitals neither with everything that is needed to deal with all eventualities in a sick patient when there should be one.<BR/><BR/>But whatever the system such fixes are politically impossible because there is always a public outcry when hospitals close. The public always want a hospital close by but they fail to grasp that if you are really sick, say, following a major accident you are better passing the smaller hospitals and going to a major centre where they have the full range of surgeons/facilities able to deal with everything ranging from your bones to your brain.<BR/><BR/>Interestingly at a meeting quite recently in a major hospital the consultant staff suggested to the management that a hospital should close. But closing any of the contenders would have caused a political furore in a marginal constituency. Also it is generally not allowed for hospitals to sell off prime sites and use the cash to build a bigger better hospital elsewhere. <BR/><BR/>There is no doubt that the old NHS system particularly with its focus on general practice has some considerable advantages and there is also no doubt that some things that are being mooted risk turning an essentially efficient way of delivering health care into an inefficient one. Unnecessary operations and investigations are commoner in some other systems. Even the NHS has traditionally done operations on a grand scale which have no good evidence base.<BR/><BR/>There are plenty of major changes which would save money and improve care in one. But privatisation and competition don't obviously seem to be the way to achieve this. However, according to the NHS chief executive (this is from the horse's mouth) some of these initiatives are just designed to shake things up. In that respect they might be a useful tool to effect change in the NHS. We shall see.Dr Grumblehttps://www.blogger.com/profile/04417731064007601504noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-90335356166766782372008-07-30T22:53:00.000+01:002008-07-30T22:53:00.000+01:00Yes, but putting in more money without making sure...Yes, but putting in more money without making sure it won't just be squandered in the system won't work either if the system itself is flawed to start with. Of course the sheer size of the NHS makes it very hard for anyone to reform, let alone undo the damage done by those who tried before them but did not succeed.<BR/><BR/>In a situation like this, remedy will have to include more reform which is unavoidable but it would produce good results if: 1- You have a person/s you trust is able to do the job. 2- you cooperate with them. There are no painless fixes in situations like this. I am sure you realize that.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-91893687451494023772008-07-29T19:28:00.000+01:002008-07-29T19:28:00.000+01:00Voice from far away, Doc G regularly has the task ...Voice from far away, Doc G regularly has the task of criticising scientific papers or applications for research grants. He has even had the job of dealing with applications for product licences from pharmaceutical companies. Despite the effort people put into these and in the latter case the millions spent it is always easy to criticise. Doing a better job is more difficult. So you have a point.<BR/><BR/>What to do if I was boss of the NHS is not something I can quickly answer. Perhaps I should do a whole post or series of posts on that question. It is not something that I have given a great deal of thought to because, frankly, nobody is going to take any notice. But when I see something happening that is obviously wrong it grieves me and I have to vent my wrath. Sometimes from the comments I see on blogs it is clear to me that what is obviously wrong to many who work within the health service is not obviously wrong to those outside. It is not even necessarily obviously wrong to those that work in other healthcare systems (such as in the US).<BR/><BR/>It is the obviousness of the wrongness of some of what is happening that may be what is leading to the frustration amongst doctors that is revealed by the blunt unconstructive criticism that you do see on the net from doctors. There is more thinking in the private doctors' chat rooms where the points being made are readily understood because of the readership. It is quite difficult to point out some of the basic truths of healthcare to those not in the business. I am not talking about medical things. I am talking about management issues related to medicine. It is easier to grasp some of these truths if you are a doctor. <BR/><BR/>For example if you put high calibre doctors into the community (GPs) and give them basic equipment and tell them to get on with it patients can end up with very cost effective care. If you put the doctors in a polyclinic with MRI scanners the scanners will be used. Patients will love it because they like tests. But it does not follow that they will be better off medically. On the other hand you do not want a system that is so starved of MRI scanners that you can never get one done when it is really needed.<BR/><BR/>If you pay a surgeon for doing an operation the patient is more likely to get an operation. But a system that restricts surgery to those that really need it is a good one. Even the NHS does a lot of useless operations. Surgeons like operating whether they are paid or not.<BR/><BR/>The NHS must give patients what they need (as opposed to what they want) when they need it. The old NHS was not badly structured to do this. The problem was that it was inadequately funded to deliver patient needs. Unfortunately government failed to realise that it was inadequate funding that was the main reason why the NHS was lagging behind other healthcare systems (the figures left little doubt about that). They misguidedly believed that GPs and consultants were on a gravy train and needed new contracts to lick them into shape. The government failed to realise how much out-of-hours work and work generally GPs were both delivering and managing. We had the best primary care in the world. Americans barely know what a home visit is. The same was true of consultants. The new consultant contract resulted in the colleagues I spoke to being paid more for doing less. The intention was to make us work harder – but they just didn’t know how much we were doing already - much of it for nothing.<BR/><BR/>These mistakes have been made. They cannot be undone. Providing 24/7 care 365 days a year was a responsibility GPs were glad to give up. But it was not good for patient care and it was not good for cost effectiveness. I don’t want to go back to my previous salary or my previous excessive out-of-hours responsibilities.<BR/><BR/>So it may not be very helpful to say so but Dr Grumble would not have made all these mistakes. He would have left consultants on a professional contract requiring them to do whatever was necessary to look after their patients in an open-ended way and he would have left the responsibility for out-of-hours medical care in the community with GPs. <BR/><BR/>Dr Grumble is a bit like the Irishman who when asked for directions says that if he was going there he wouldn’t be starting from here. That’s why Dr Grumble tries to stop the government making any more silly mistakes. Left to his own devices Dr Grumble would have put the extra money into the NHS without the new money-wasting initiatives. He thinks that would have delivered. If it had not a shake up would not have been unreasonable. One problem was that the government put the money in too late and put itself under pressure to deliver results quickly. They have shot themselves in the foot and seem now to be pointing the gun at the temples.Dr Grumblehttps://www.blogger.com/profile/04417731064007601504noreply@blogger.comtag:blogger.com,1999:blog-25200961.post-89379930211553450372008-07-29T16:07:00.000+01:002008-07-29T16:07:00.000+01:00and pardon my spelling .. 'shame, shame, shame ..'...and pardon my spelling .. 'shame, shame, shame ..'Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-52495476982008219182008-07-29T16:05:00.000+01:002008-07-29T16:05:00.000+01:00Hi doctor GI have just read 'Let the market rule. ...Hi doctor G<BR/><BR/>I have just read 'Let the market rule. I would not like to see the NHS privatised but I also would not like it to go from bad to worth because of waste and mismanagement. I have a small business myself and know exactly what it means to be in trouble myself; during the Gulf war 1, I had to sub-let part of my prmises to support my cash flow, otherwise, I would have definately gone down. So, sometimes hard decisions have to be made to avoid catastrophy. I always understand macro economics by simplifying matters to the smallest denominator, find solution/s, then enlarge again to suit. However, the majority of docs on the net just crtique and never attempt to put forward solutions except rarely! I trust your opinion and would appreciate your input on what to do if you were boss? If the situation as is is not 'tenable'Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-25200961.post-60394882031895450972008-07-27T19:16:00.000+01:002008-07-27T19:16:00.000+01:00Finally, one of you gets it. The NHS costs a lot ...Finally, one of you gets it. The NHS costs a lot of money. The government wants to dismantle it. Doctors resist this and so do their patients. Therefore the trust in and influence of doctors must be reduced by means of (1) deskilling doctors and upskilling nurses and (2) undermining of doctors' authority and influence through the media.<BR/><BR/>The sooner doctors come out of denial about this the better. Government really doesn't think about patient care - you're right, these are mangement decisions based on budget.Anonymousnoreply@blogger.com