04 March 2010

Polysystems and Rich Pictures

Sorry. If you were hoping to find out what a polysystem is, Dr Grumble doesn't know either. It is probably a few months since Grumble first heard the term but he still doesn't know what it means. Words without meaning frighten Dr Grumble. It's perverse for a word not to have a meaning. It is the raison d'être for a word to have a meaning. Sometimes words without meaning have a dangerous purpose. Their purpose can be not to convey a meaning. Not the real meaning anyway. Do you think that might apply to the word 'polysystem'?

What is the essence of the polysystem approach? Ostensibly it is about providing care for patients closer to their homes. That sounds laudable. It is also supposed to be cheaper. Why it should be cheaper Dr Grumble has no idea. If you provide the same services that are in a hospital to patients that are in the community it is not at all obvious to Dr Grumble that it will be both better and cheaper. The MRI in the polyclinic at the end of the road has never been a realistic option. And while handheld ultrasound scanners may get us a fraction closer to the dream of Spock-style Star-Trek diagnostics the reality is that in the 21st century a scanner is only as good as the bit between the ears of the person operating it. Quality diagnostics is not just about providing the necessary hardware at the street corner.

The more you think about the idea of moving care into the community the more daft it becomes. It is not a bad ideal but it just can't be cheaper and better. In the current financial climate it may not even be affordable. So why the headlong rush for a model of healthcare that has never been tried, is totally untested and has not been costed? That is today's big healthcare mystery.

But wait. Dr Grumble is making the mistake of assuming that the primary purpose of polysystems is to move care closer to patients' homes. That after all is what we are being told. But is this the real purpose? Are our masters so misguided as to really believe that polysystems are going to be both better and cheaper? Of course not.

兵不厭詐 (兵不厌诈)

There is only one interpretation that makes any sense to poor old Grumble and that is that this whole polysystem thing is not much about improving patient care. So what is it all about? What is the dangerous hidden meaning behind this ghastly newspeak? Why has this new word with no meaning been contrived?

The horrid truth is that this polysystem thing is about chopping up the National Health Service into lots of little pieces and then getting rid of it. It could be privatisation or it could be something else. Exactly what doesn't trouble our masters too much. What it won't be is the NHS. The components of the polysystem will be called NHS providers and the NHS will pay but the provision of care will come from bodies that are not actually the NHS as we know it. The details are vague and uncertain - quite possibly deliberately so. Vague enough to be depicted as a Rich Picture (pdf). For some it will be a very rich picture. For most of us it will be quite the opposite.


Anonymous said...

As has been said before....

High Quality Health Care
Faster Health Care
Cheaper Health Care

Pick any two, but you can't have all three.

Prisoner of Hope said...

I too have no idea what a "poly system" is or could be BUT .... I do seem to remember health policy discussions 20 years ago talking not only about a purchaser provider split but also moving to a "plurality of providers". The discussion then moved onto identify that perhaps the NHS at local level could also develop into a system based on "plurality of purchasers".

Early attempts to achieve this included GP fundholding practices. More recent attempts to resurrect this idea of GP consortia seem to have run out of steam.

So if the monolithic NHS of the past (where a single authority both purchased and supplied health care at local level - paid for by taxation) is to be replaced with a system consisting of BOTH a plurality of providers (competition, contestibility ... choice!)AND a plurality of purchasers (GPs, PCTS... HMO's anyone?), then we might describe such a mess as a polysystem for the purposes of the delivery of health care - albeit to a local community still paid for out of taxation.

If this is ever achieved all that would remain of the old style NHS would be the funding from taxation as part of a truly national insurance based approach to health care. Sadly it will then only take a small change to allow top up funding and then financial compensation for taking out private health insurance as the Conservatives have argue for before. This in turn could well encourage the complacent and contented majority to argue against state funding and from a "polysystem" funded primarily from taxation we will have arrived at the "two tier system" health care that many dread!

I suspect therefore that the term "polysystem" describes a convenient staging post before a 2 tier health care system becomes a reality and both the term and what it represents should be resisted while there is still a chance to do so.

Dr Grumble said...

I fear you are right, Prisoner of Hope. And we will all be losers as a result.

Anonymous said...

Quite right Grumble. Services are being moved out as they are hard to privatise while within a hospital. The plan is to move all but the most specialised outpatient work into polyclinics as they can then be carved up through private tendering.

Kaiser Permanente chronic disease programmes will be used to manage most conditions. You might get into hospital for a diagnostic clinic, but as you know chronic disease follow-up is actively discouraged.

(trainer 1)

Dr Aust said...

What I can't work out is why no ranking journalist ever points out that this will be more expensive overall. The German style system, with "cardiology clinics" or "paediatric clinics" in the community, is more expensive than the NHS model, presumably in large partly because the clinic infrastructure must be repeatedly duplicated, and I assume also because of more complicated billing/charging. And I was always given to understand that set-ups like Kaiser made money largely by managing not to treat under-insured (but "illness rich") poor people.

It is deeply depressing that, after the banking fiasco, the political class is still slavishly devoted to the idea that markets automatically deliver the goods.

Dr Grumble said...

What I can't work out is why no ranking journalist ever points out that this will be more expensive overall.

As you say, Dr Aust, it is utterly obvious that the way we are heading will cost much more and not less. Journalists have a duty to point out the errors of the ways of our masters but they don't. If you want to understand why they are not doing their job watch the video I posted here which gives some but not, I think, all of the reasons.