That NHS Listening Exercise in Full

From the LRB blog,

"...there’s more to the listening exercise than a website. Paul Burstow, the care services minister, announced last month that 119 listening events had been planned. 119? Impressive. It would be nice to see a list. Apparently if you ask for the list you are told to contact NHS Future Forum. But it turns out that NHS Future Forum does not take incoming calls. Not, it would seem, that kind of listening exercise."

No need to even pretend to listen now, I'd say. It was always about keeping the junior partners in the coalition happy anyway. Those pesky Lib-Dems have been put back in their box via the AV vote and local elections, so Lansley is probably going to get a clear run at his intention of dancing on Nye Bevan's grave.

& hey- sometimes it really is true that you need to go ahead with a war because the railway timetables say so, as it were. At least that's what the NHS chief executive thinks.

Addendum: of course the really clever thing would be for Cameron to sack Lansley - and appoint Clegg to carry out Lansley's NHS plans which are now hurtling down the track towards reality.

Thoughts on Spending 31 Hours in a NHS A&E; with a 87 year old

What, I wonder, would the various denizens of the blogosphere have been saying if they were sitting there with me and my ailing Mum?

The rabid right-wingers would have blamed the incentive-free state bureaucracy I suppose. But they would be wrong there; I really don’t think it had anything to do with the governance arrangements or lack of a direct profit motive. The people, from the consultants down to the porters and cleaners , did seem genuinely open, friendly and willing to help.

Most of my comrades on the left might have muttered about still catching up with years of underfunding, and there were certainly evident staff shortages , though mainly, as far as I could see, unpredictable ones as at least two nurses went off sick in that 31 hours. It’s hard for any organisation to deal with that.

My blogroll’s resident HR expert might have had something to say about the composition of the staff team though; to be frank I thought there were too many doctors and not enough nurses. This may seem an unusual complaint. It only makes sense when one realises that the doctors appear to operate in separate little kingdoms of medical specialism. About a third of our wait was simply down to the A&E team referring some x-rays to the orthopaedic surgeons for a second opinion on whether there had been a fracture. And whilst we waited for that second opinion nothing else happened, no temporary admission could be made because the separate specialist kingdoms hadn’t decided whose kingdom (i.e. what kind of ward) Mum was going to be admitted into. I believe this is called silo working in management speak. Meanwhile the nurses on A&E were doing their A&E thing which, when it comes down to it, is basically triage. So if someone is marked as awaiting a second opinion they just move onto the next case unless there is some urgent call from the bed which has been parked in this triage operation. No thought beyond basic feeding and toileting is given to the cases not identified as urgent. If there had been more nurses the various doctors’ instructions might have taken effect rather quicker – and more holistic care might have actually been provided. Also, I’m not certain why it would have been such a great disaster to get Mum somewhere comfortable, even if it did prove to be the wrong ward and meant her having to be moved the next day.

My blogroll’s representative Spiked-influenced commentator and general enemy of the risk adverse culture would also have passed a few harrumphs about the reason for the final section of our wait – the seeming impossibility of assembling two spare members of staff to push the bloody bed containing my Mum to the ward. First we got a single porter; then we got a cleaner but no porter, and finally, 4 hours after the consultant had instructed an early transfer to a ward, we got both. Of course I pleaded and pleaded to be allowed to help to push the bed myself – but, no it was ‘against the rules’, 'not procedure' there were Health and Safety concerns and so on. So Mum sat waiting, immobile and in semi-public view, in A&E till two people could be assembled, one to push the bed and one to simply open the doors and push the lift button.

But most of all I reckon Boffy will be slowly and sympathetically nodding his head and biting back the urge to say, "I told you so - the left has got to be about more than just knee jerk defence of the NHS" . & so he did. Several times.

Of Health and Social Care

The Observer leads to day with the – oh, so shocking – news that quite a few of the Tory front bench, including that nice Mr.Gove, have endorsed Daniel Hannan’s call for the NHS to be replaced by a new system of health provision in which people would pay money into personal health accounts, which they could then use to shop around for care from public and private providers. Those who could not afford to save enough would be funded by the state.

Which rather sets the stage for health being a central election issue, this time, no doubt, with Labour tying a big pink ribbon round the NHS and claiming to be the ‘patriotic’ party in defending it not like those horrible market obsessed US-wannabees in the Conservative Party. Oh no, no like them at all.

Except of course, in the small matter of social care, where Labour Ministers never miss an opportunity to big up their commitment to individual budgets and self directed care.It's basically the same idea, just transfered to a not-that-dissimilar sector.

Socialised Medicine: May Contain A Worse Threat Than MRSA....

Slugger led me to a long, long debate on American Healthcare Reform over at Reddit. My favourite comment is about 1000 down, from a Canadian coming to terms with the US system now he's living south of the border:

If you're American and have grown up used to the idea of a private health-care system, try picturing this: Imagine going to a new country and finding out that to call the police was for-profit, and you had a variety of options for licensed police services. If you paid for a good plan, you'd get sub-5-minute response times, you'd get detectives assigned if your car was stolen, and you'd have a cop patrolling your neighborhood on a somewhat regular basis. If you were on a budget, you'd only get a 10-minute response time, and no detectives assigned for major threats or patrols

Well, yes, most of you might think. But as another poster warned, there can be hidden dangers to thinking this way:

But aren't you glad that the government didn't tell you what doctor you had to go see? Like they don't do in any socialized medicare country that I know of? Haven't you considered the various imaginary problems that socialized medicine could cause? You know even talking about it could turn you communist like every other western nation. I'm a Canadian and I've seen people come out of hospitals drop to the ground and suddenly become communists, happens all the time.

Update: Sean at The Soul Of Man under Capitalism has a brilliant Fox TV clip where they seriously discuss the idea that socialised medicine encourages jihadist doctors...