14 October 2012


Was it here or on Twitter that I referred to Britain as the world's oldest democracy? I can't now remember and it doesn't matter. I can't even remember whether the ticking off I received was because we aren't the oldest or because we aren't a democracy. But it did set me thinking. I don't like to be wrong but I do like to be put right. That is the great strength of the wonderous new media of blogging and twitter. You can say something and be put right. There have been some interesting antics on twitter recently when people with entrenched views block those whose views differ. These people do not want to hear arguments; they just want to express their views. Banter with people like this becomes as sterile as an argument on the existence of God between Richard Dawkins and the pope. There really is no point.

One, but only one, of the reasons I had a blogging break was that I was a bit irritated by a very small number of these individuals with one-way minds making comments. They are not the sort of people who engage with arguments. They just want to sound off. And, since their arguments tend not to stack up, they bolster their ill-considered views with invective to try and give them some strength. I know that the louder they shout the more wrong they are likely to be but it does tend to render the debate somewhat sterile.

I have never really thought that I live in a true democracy. The world's oldest democracy is just a stock phrase I trotted out. It probably stems from the ruling classes intent on giving us plebs the illusion that we have some control over our lives. We don't. Not much anyway.

This point was brought home to me the other day. A group of local GPs came round to talk to the consultant body. It's an indictment that, although I knew all their names, I had scarcely ever met one of them before. Worse, for the first time, I met consultant colleagues I regularly correspond with. That's the modern hospital for you. The days of meeting people in the consultants' dining room are long gone. It been replaced with a snatched sandwich - and that's if you're lucky. It was clear that the GPs have a similar problem. Not only do they not know the consultants, they rarely meet their GP colleagues either.

The really surprising thing was the illusion these GPs had about the power of the consultants in the hospital. I have picked up this misunderstanding before from online comments from GPs. They really don't understand. GPs, you see, have very great influence over their own surgery. As many politicians like to point out, they are independent contractors.

If you are a senior GP you remember hospitals as they used to be. There was an illusion then that the consultants were in charge and ran the hospital. Perhaps there was a time when they did or, at the very least, they were listened to. But that was way back in history.  They don't now. Not at all. They are scarcely listened to.

So why this extraordinary meeting with some local GPs when we all met for the first time? Well you've guessed it. It has to have been some sort of crisis. And you don't have to be very bright to guess that the Grumble hospital might be under threat of closure.

This then was what the local GPs came to discuss. They assumed that the consultants of Grumble hospital would have had in-depth discussions with the management about the hospital's future. They assumed there would have been lots of agonised discussions and hand wringing about the future of the hospital and what the consequences might be for our patients and for local GPs. It was an eyeopener for them to discover otherwise. One of Grumble's colleagues pointed out that our Chief Executive, when announcing some plan nobody much liked, announced that the hospital was not a democracy. It's not. It never has been and it never will.

Like most meetings nothing much came out of it though the GPs certainly learnt just how impotent today's consultants are. The interesting point for the consultants, though it may not have been a surprise, was that the local GPs had also not been consulted by their masters on the hospital closure. They had taken part in a formal public consultation process but, as was pointed out to them, formal consultation processes are more about telling the populace what is going to happen than listening to their concerns.

Does any of this matter? My own feeling is that we could do with a few benevolent dictators. But the  hospital closures are not being driven by a need to improve healthcare by having fewer larger hospitals. The driver, though it is never admitted upfront, is a desperate need to save money.

Towards the end of the meeting the GPs launched their bombshell.  If the planned loss of 1000 hospital beds goes ahead, there is no evidence that care in the community can take up the slack. This concept is just a management consultants' pipedream with absolutely no data to support it.

By then all the managers had left.


Anonymous said...

I work in the Community. The local Trust to which we in the "Community" now belong are closing 4 wards and getting rid of 470 staff to save 2 million. We in the "community" have been told that we will have to " learn to work in a different way" so that we can care for people who can no longer be admitted because there will be no beds. We are to be given a few extra band 4 staff to help deal with this.

Dr Grumble said...

Incredible isn't it? There might be ways of doing what they want but, if there are, they certainly haven't been worked out or properly planned.

This madness is happening everywhere. The emperor has no clothes.

Anonymous said...

Acute trust has been cut cut cut. Acute hospital kicks patients out sooner - govt says community trust will be there. Patient not ready to go it alone and, low and behold, community as cut as the acute trust, so no extra community back-up for pt. Pt gets re-admitted soon after with problem relating to original admission. Acute trust gets fined. Acute trust has less money.....

Ooh there's a song in there somewhere....

Anonymous said...

Welcome back Dr Grumble,

Increasingly it looks like the structures of the CCGs are completely unready for the end of PCTs and them going live in April.

Combined with the similtaneous start of revalidation it is going to be a hard year.

Best wishes

Dr Phil