A few days ago, I met a consultant who told me patient care has become worse in the past five years. She mentioned a number of things that were worrying and/or were making the business of treating patients more difficult.

1. The NHS management has imposed an expectation that, in her speciality, there should be two follow-up meetings with patients for every one meeting with a new patient. This target varies from one speciality to another. Her target is, as far as she is concerned, wholly arbitrary and damaging to good patient care. She believes that good care requires, on average, a higher proportion of follow-ups. But if the hospital fails to keep to the proportion prescribed, then it will lose some funding. So an attempt must be made to keep to it or to fake it.
If they were to keep to it, then patients who needed to be seen more than twice after the initial visit would suffer. She suggested that therefore, in order to maintain good patient care despite the target, they fake it - at least some of the time. They call an old patient a new patient. Presumably they pretend that the patient has a new ailment whereas, in fact, it is the continuation of the old one.
How depressing it is that senior doctors have to spend their time getting around silly rules rather than devoting themselves to their job of looking after patients.

2. She told me that doctors gain the status of consultants far more quickly than before. Previously they spent four years training generally and then another seven years in their speciality. They also worked all hours, thereby seeing a great deal of illnesses and their treatment. Now, however, they can be called 'consultants' after only five or six years and they have had significantly less experience in those years than they would have done previously because of the new rules limiting their working hours. A consultant today is often not the highly experienced top doctor that he or she would have necessarily been in the past.

3. Another effect of the new working hours is that the new consultants more frequently than before have a shift mentality. When their time is up, they go home regardless of the state of their patients. This is a change from the time when a consultant very frequently felt his or her prime responsibility was to the patient and that this would quite often mean he or she would stay around until a procedure involving the patient was complete.

4. She told me that there is a drive for doctors to account for everything thing they do. She said that in one hospital, I think it might have been Great Ormonde's in London, they were trying out a system whereby doctors would account for each thing they did for patients on a personal digital assistant (PDA. I remarked that I had recently seen another consultant in a different hospital swiftly moving from task to task - ordering an X-ray for one patient, asking for another patient to go to his office, consulting with another doctor about a third patient, examining the second patient, looking at X-rays for a fourth patient, having a word with the relatives of that patient all in quick succession. If he had had to itemise such things, he would not have had time to do them. She heartily agreed. In trying to monitor such things, the administrators were going to damage the productivity of doctors and thus damage patient care.

5. She also remarked what a vast army of people there must be doing all the monitoring of targets. Somebody from her hospital would have to collate all the figures showing whether or not she was meeting the unnecessary and damaging target of two follow-up consultations for every one initial consultation. Then the information would have to be sent to the central administrators who would have to check and analyse the figures. I presume someone would have to decide if the funding should be cut. Letters and warnings would be issued and replied to. Someone must also have been paid who thought up the idea. Someone must have thought up how it should be implemented. Stationery would have been designed, printed and distributed to hospitals. And so on and on. One bad 'bright' idea. Hundreds more people employed by the NHS to produce no improvement in treatment. In fact their employment damages patient treatment since their wages and costs such as office space, heating, lighting, pension rights and so on have to be taken out of the NHS budget and taken away from patient care.

I had spoken to this consultant when researching The Welfare State We're In. She told me that she thought things in the NHS were bad then but they are worse now. She also remarked that having damaged the NHS, the regulators and administrators have also moved in on the private sector, requiring more and causing more damage even to the private sector.

6. There is a requirement now that hospital consultants can only do certain treatments if the hospital concerned has beds that are suitable for that particular speciality. Presumably this is in case there is a mishap and the patient needs a hospital bed. But the result is that hospitals where a consultant used to do minor treatments immediately and on the spot are not allowed to do this any more. In the past, the consultant could decide whether or not it was wise to do such treatments. Now he or she is not allowed to decide. The patient has to make a new appointment at a different hospital, quite possibly seeing a different consultant who has to learn about the case afresh. Patient time and care is damaged. More consultant time is wasted.

She painted a very depressing picture of how the NHS is being administered and how even the private sector is being interfered with and damaged by government.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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