Wednesday, December 15, 2010

Doctors - should they be trusted to run NHS?

The government is pressing ahead with plans to get doctors to manage the NHS should they? In a word no or NO NO NO at least that is my view.

Its simple the police don't run the judicial system because their expertise is in catching crooks and enforcement.

At the risk of being struck off from my current surgery, here's why I think it would be wrong. First off, over the last few years doctors, particularly GP's have dramatically increased their earnings while reducing the hours they work. Clearly a doctor should not have to work too many hours but certainly improvements for general practitioners have pushed up costs.

Hopefully the average doctor is expert at dealing with illness and the best ways to treat patients, I'd imagine like any other profession most doctors have an opinion of how their NHS or industry should be operated, still since most patients experience difficulty in getting to see their doctor, what is the likelihood that doctors have the time to get that involved or manage.

As a rail maintenance worker, working for a contractor I have an opinion on how Network Rail should be run but since I'm at the bottom of the food chain, its probably best that those who manage continue to do just that. If changes are needed then government should direct management.

With the NHS the government, should simply issue the chief executives of each health authority, with objectives a budget and make them achieve it or sack the top tier of management, until each health authority is run efficiently.

Finally do doctors actually want to run the NHS? Probably not otherwise they'd no doubt have trained to be managers and accountants.


  1. I see what you are saying about conflict of interests but at the same time the best IT manager is an IT guy not a manager. When you have an IT guy running IT management the department is efficient and proactive when when you have a management school guy as manager he becomes another problem for the IT team to manage.

    Likewise the theory is that GPs with their own financial situation under their own control are going to face market conditions. In other words if Surgery A closes at lunchtime Surgery B can pick up a lot of custom by opening at lunchtime or staying open.

    It is not without the bounds of possibility that we would see 24 hour GP surgeries with GPs working rotation of shifts. That way the practice could see a three fold increase in income. Especially if they get in there first.

    Politicians are not great at running the service and I'd be happy to see the GPs given a trial run on the grounds that if they screw up or the public hate it we go back.

    The only way to be sure is to suck it and see.

  2. I too doubt GP's need any extra work and will employ managers to manage, but they would not be on the NHS payrole. I dont like the idea but as the previous post said lets suck it and see.

  3. The country cant afford at the momment the £3 billion the transition will cost.
    My local surgery cant even manage a decent appointment system and simple things like having a blood test can take 2 weeks.
    This could be the first step in privatisation of the NHS with groups of surgeries forming a company to take on the task and outsourcing much of the admin work and even the treatment decision making.
    Under the coalition we already have the scrapping of hospital treatment waiting times and there is proof that even waiting times for cancer treatment have already increased.
    Its only December but the local PCT is already putting off certain treatments unil April and Tony, you recenly commented on the other delaying tactic of not treating the overwieght and smokers.

  4. At the risk of sounding repetitive, Tony, we must first take our country back. Weed out the dark forces that are striving to make our lives a living hell... literally.

    Once we have done that we can have health care which actually lives up to it's name and a medical staff that can actually take pride in their work and their hospitals.

  5. Yes they can do a better job.


    Water Authority (WA) wanted a new treatment process installed. The rep from a German manufacturer arrived in his VW.

    Once WA had agreed in principal the manufacturer sent an engineer in a BMW.

    The WA deployed a team to agree the contract. The German engineer came alone. What about the legality of the contract, the penalty clauses, the costings ? Simple stuff he said any engineer can also do this.

    When the contract began up turned the same engineer as in charge of site. Towing a caravan with his BMW to live on site.

    Contract comnpleted, commissioned and delivered on time within cost.

    Asked would he ever become a manager the German engineer answered "Of course when I become a little older and can afford the pay cut and settle for a comfortable life supporting the engineers at the head of the company".

    STORY 2

    First Lithotriptor installed in UK (Joint NHS and BUPA at St Thomas Hospital)

    The European engineer saiod that UK is the only country in which he has to stop work at 5PM and not just work through until the machine is installed and commissioned. Reason ? NHS Medical Physics Depts work office hours and overtime would need management authorization.


    Repair and research budget Medical Physics Dept. In the mid 80s mine was £1500 per week. Each Friday the Chief tech would call on the techs and ask us toi spend the balance of the £1500 if necessary at random. So out would come the RS catalogue and we would order electronics components to the value.

    One Friday the Chief asked why I was not ordering certain chips and components as my predecessor had ordered several hundred quids worth a week.

    Video player and colour TV spares I told him. Did his family own TV shops at all ?

    "Yes" he said "You better order a few hundred quids worth to stop management spotting it"

    STORY 4

    Serviceability stats for linear accelerator treating cancers in medical physics dept.

    Based on using the machine Monday office hours, Tuesday office hours, Wednesday office hours and Friday office hours

    Wot appened to Thursdays ? Shut down for maintenance.

    Hence a million quids worth of cancer treating kit used office hours only four days per week.

    STORY 5

    Because the machine is only available four days at office hours what about fractioination ?

    If it is better for a patient to be treated with smnaller doses of radiation but more frequently ? No his plan has to take account of the machine only being used foyr days office hours.

    STORY 6

    Principal Physicist tries to crteate an asset register of the test equipment and tools held by his and other London teaching hospitals so as to avoid duplication of purchase and increase the range of specialist test equipment available within the teaching hospitals.

    Stopped by management.

    This is due to a management parasitic mnaggot effect called parallel departmentalism. Each dept gets its budget and all must defer to layer upon layer of parasite managers.

    Each dept then pulls tricks (see above) spending money needlessly to defend the budget. IE So the parasite managers don't spot the budget can be cut. To avoid the danger of cost cutting parasite managers getting carried away with their own importance.

    But the threat of department talking to department that had to be squashed by the management. Whatever next .. left to their own devices the oncologists, engineers and physicists might start delivering a proper service within budget and the managers be sacked ?

    Finally on the subject of sabotage. An Armenian engineer working in UK told me that UK management is a standing joke abroad. A country obseessed with having someone in charge and appointing people who know nothing about what they in charge of.

    The Institute of Electrical Engineers published research about the UK industry in 84. They found 93 % of managers (sponging a living off the backs of engineers) totally unqualified either by experience or qualification. 3.5% had tech qualifications and 3.5% had business, management or arts qualifications.

    Just get away from the Thatcher model of manager right to manage. Substitute the German idea that managers are support echelon led by the greater professionals actually doing the task.

    Then see how many "Managers" are sacked by the professionals once the pros are in charge.

  7. One last tale Tony

    I designed a installed a timer controller modification for Physio infra red treatment machine.

    The principal physiotherapist was made up so wanted all his IR machines similarly modded.

    Unit cost say £100 (80s). Dozen machines say.

    Medical Physics then ask Physio to pay. He says his budget can't afford it. WE say our budget can't stand it either and it don't get done.

    That Friday I spend at random, enough money to have done all the Physio machines, on components we don't need.

    Probably the Physio Dept was lying about having no spare in their budget as well.

  8. Having read through Retired's stories I am too exhausted to contribute. Sure there must be some sense in there somewhere but I fell asleep before I found it.

  9. No they shouldnt unless they are doctors like Dr Mercola

    Doctors are highly over paid for the limited services they provide and linked strongly to the drug companies.

    If anyone still believes that anything run by the government is good for us , think again, why do you think they go private themselves.

    Lastly look at the amount of common purpose graduates running the NHS and every other government business , not good .

  10. anon 11.42 I agree

    hmmm... there's lawful rebellion - peaceful mass civil disobedience - then there's civil war - in 99% of cases instigated by agents of Government as an excuse to impose martial law and clamp down on liberties.

    The Romans tried that. Their civilisation was destroyed from within.

    Several English monarchs tried that, too. The last one was ...Charles II.

    He was decapitated.

  11. Oh dear Anonymous 11:42. Charles I was beheaded, Charles II was his wastrel son. I'm struggling to think which other English monarchs instigated civil wars in order to impose martial law and clamp down on liberties. Stephen and Mathilda; no that was about who was going to be Top Banana. Wars of the Roses. Same really, just went on a bit longer. Nope, can't think of any so this observation clearly falls into the category of "I don't know what I'm talking about but all right-thinking people hate the Monarchy so I should be all right blaming them."

  12. Very well put, Andrew, but why let the facts destroy the story, or should that be plot. Having ruffled his feathers, our resident conspiracy theorist will be back at you with some salient fact (or web link) which probably is not fact but either hearsay or opinion. He has been doing it for years and even posts further comments in support of himself.

  13. The Admiralty, the War Department and the Air Ministry were fine when they were largely run by sailors, soldiers and airmen. It all went to pot when they merged into MOD and the civilian management numbers escalated. Thereafter the forces largely got the wrong equipment, well over budget and invariably too late or not at all.

    Let the professionals run their own shows. Can you imagine Man United having a manager who had never played professional football.

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    I considered this, then answered: "Democracy, son, is as illusory as is the concept of time. As real as it seems, it is a lie born of men, yet people like me send people like you to die in the name of it and to protect the illusion. To protect the lie. This is something I will never ask of you."

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