Monday, January 02, 2006

Angry As The Doc

My good friend, the very angry Dr Crippen, blogged about it last month. In fact he is so incandescent about it, that it was one of his very first posts.

It is cardiac ablative surgery, like Tony Blair had. But the Doc has had great trouble getting it for his NHS patients who don't happen to be the great and the good:

"For each and every patient, I have to convince an administrator. These administrators are clerical officers. They are not medically qualified and have neither the specialised knowledge nor often, it has to be said, the intellectual equipment to understand the intricacies of ablative surgery for cardiac dysrhythmias and other complicated medical procedures. Nonetheless, they have the power to sanction or deny my request for the “out of area” referral and they have a committee that convenes from time to time to advise them."

And today we find that Doc's unfortunate patients are very far from alone: "Around 50 patients in Oxfordshire and Buckinghamshire who had been referred to the heart unit at the John Radcliffe hospital in Oxford have been taken off the waiting list and told they cannot now have the operation on the NHS. The numbers will build up over the next year."

Naturally the loathsome Commissar Hewitt immediately blames the Radcliffe:

"We cannot have a position where Oxford or a few other areas of the country are overspending on these hugely increased budgets. I am proud of the fact that we have set a target that nobody should be waiting for an operation or a hospital treatment for more than six months."

Which is pretty rich, given that it's the targets themselves that have triggered the JR crisis. As one exasperated cardiologist said: "There is clear evidence that the main motivator for removing patients from the waiting list and denying new patient access to ablation treatment is the need to meet government six-month waiting list targets."

As the Guardian notes:

"The crisis has been brought about by the under-pricing of the procedure by the Department of Health, cardiologists believe. The department sets a tariff for every treatment, and cardiac ablation is set at £2,000 - but it costs Oxfordshire twice that. It means that Oxfordshire is making a loss on the procedures it carries out, and yet demand is so great that the trust has had to pay for many to be carried out in the private sector, to keep within the six-months waiting list target. Cardiac ablation costs £7,500 to £8,500 in the private sector."

Sound familiar? Yes, it's that same deadly combination of targeting, psuedo-market reforms, price-fixing, and large dollops of bureaucratic micro-management that finally brought down the Soviet Union. Professional judgement, clinical priorities, and even common sense must all take second place to satisfying Whitehall.

What New Labour have proved beyond doubt is that pumping more money into a Soviet-style NHS not only fails to produce results. It's positively dangerous.

No wonder the Doc gets angry.

Update: Doc's second post on this is here. Well worth choking over.

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