Monday, January 22, 2007

Tory Health Targeting- Half Right

If you're sick, please go away

So Andrew Lansley would abolish the government's centralised health targets for waiting lists etc:

"We have reached the absurd situation where waiting-time targets are being turned into a minimum wait so you have got local NHS bodies telling the hospitals that they cannot treat patients before, say, 20 weeks because they cannot afford to pay for it and because the waiting-time target says they should be seen at 20 weeks.... One-size fits all targets are not the right way forward."

Quite right too. Tractor production targets simply do not work.

But his alternative is also riddled with obvious problems.

Under his plan, GPs would once again become proper fund-holders, would be given back more of their discretionary power as "gatekeepers", and relieved of all those counterproductive targets and box-ticking duties. Instead of being paid to tick boxes, they would be rewarded for "outcomes"- eg how many of their patients survived five-years after a cancer diagnosis (five-year survival being a international standard measure).

Fund-holding GPs would thus have both the scope and financial incentive to use their professional judgement in deciding the best treatment. The focus would be on final results, not on process. Much better all round.

Sounds intuitively very appealing, doesn't it.

Or does it?

Look, I'm a GP. But unlike the Doc say, I'm a Goldman Sachs style GP, with big red £ signs constantly flashing in my eyes. I look at Lansley's new system and I say "aha," I say, "aha, this means I only want healthy patients."

So I look at my list and I start by chopping all the smokers. Then I start on the fat chavs. I hire Mr Gomulka's dog-team to visit them in their homes with the message to loose 5 stone within a month, or piss off. Drink problem? Chopped.

Then I start on genetics. Obviously anyone with a family history of heart disease or cancer would be shown the door.

New applicants for my list would have to fill in a 30 page health and lifestyle questionnaire, provide references, and undergo- and pay for- a detailed health screen. And just like life insurance, any porkies which subsequently come to light would be punished by immediate exclusion.

I might go further. I might find ways of encouraging any of my patients who got say a cancer diagnosis and looked like they weren't going to make 5 years to move elsewhere. I could envisage arrangements with "partner practices" specialising in such cases. For an appropriate fee of course- fees driven directly by the the DoH pricing tariff itself.

And then of course there are all those old people. Very expensive at the best of times, and frankly anything can happen. An outcomes tariff would need to be pretty juicy for me not to chop the lot... er, resettle them with a specialist partner provider.

Speaking as a 56 year old who's clocked up just under four years of post-cancer survival, I'm nervous.

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