Although one would expect the current ills of the NHS to be multi-factorial it has been suggested that much of this is down to the Wayne Rooney syndrome, where the exorbitant financial demands of superstar footballers and their tetchy relationships with managers are bankrupting football clubs1. It was also suggested that the NHS in the 70s and 80s was “rubbish”. This novel diagnosis has much to support it but the notion that its aetiology is in some way tied up with healthcare delivery 30-40 years ago requires more thorough evaluation.
Furthermore, if we are the cuckoos in the healthcare nest and are eating our exhausted providers out of house and home, then is it not time for us to get a grip?
My memory, as a new hospital consultant in the 70s, reminds me of a time when service aspiration and our professional relations with patients produced vocational rewards which outweighed the financial limitations within the NHS. Those patients, who could not abide the miserable accommodation available in the NHS and had the money, willingly bypassed the system, providing thereby the financial lubrication for alternative private pursuits. However, the hospital managers of yesteryear were by and large our politicised empire building colleagues who tended to cherry-pick those projects which enhanced their own departmental importance. As most of us beavered away with our heads in the sand, we did not see the inevitable birth of a new healthcare religion where medically naïve bureaucrats could both control the purse-strings and sell a healthcare agenda to the public in return for their votes. The logical prioritization of healthcare had at a stroke been taken away from those best able to evaluate the needs of patients.
The generalists of 30-40 years ago, whilst professing a special interest, still had to provide succour for those dying with organ failure and malignancies that did not lend themselves to the surgeon’s knife. Watching a patient die from potentially reversible renal failure was harrowing for all concerned, but this was not solved just by appointing a Nephrologist. This was often the sort of pass the patient attitude that achieved nothing without the necessary investment in infrastructure. Doctors without the tools were as useless as footballers without boots and yet many district hospital managers failed to appreciate this. In time defects in infrastructure were addressed only for new diversions to emerge to distract promotion hungry junior doctors.
Setting out as a junior hospital doctor in the 60s was not an unpleasant experience. A salary of about £7 weekly, once compulsory residence and subsistence had been subtracted, may have compared poorly with a builder’s labourer who could earn £10 weekly without even having to do overtime, but the vocational rewards were substantial. The prospect of earning about £75 weekly as a whole time NHS consultant, provided one could negotiate the tortuous and gruelling academic path ahead, may have been an incentive but not the raison d’être. A generous pension at the end of one’s career was a bonus but, after 40 years on a hard saddle riding over rough ground, few senior doctors survived long enough for the pension pot to be compromised.
Driven by junior doctor http://imagineear.com/pharmacy/buy-adipex/ activists, the terms and conditions of pay have become so distorted that aspiring consultants find themselves doing less frontline work for more money and assured of a consultancy without even having to break sweat. As a result consultant numbers have escalated and survival long after retirement is now the norm. With such an abundance of doctors and generous NHS salaries, do we really need to have senior doctors with feet both in the NHS and the private sector? This has always been such a sensitive subject that mentioning it could readily ostracise one from ones colleagues. In spite of the denials from those in private practice, this duplicity sooner or later becomes the source of a conflict of interests. The hospital service would not be starved of human resources if consultants had to choose between being wholly employed by the NHS or becoming a fulltime private practitioner. Hospital managers would always have the fall back position of being able to hire a consultant from the private sector for a specific task.
So, how do you rebrand doctors without destroying the advances that have improved patient care? The first step is to admit that we are part of the problem. Then we can begin to make some progress. As for the politicians, they need to stop making half hearted and often devious changes to the bureaucratic process4. Their most recent pronouncement being to devolve their healthcare functions to the people who pay for and rely upon the NHS. In that situation the Healthcare Commission, Monitor and SHAs could be disbanded (with enormous financial savings), but not in the devious minds of our political masters. Freed from parliamentary interference, local communities could both decide how to spend the limited resources available and monitor the performance against standards which they set themselves. The UK is composedof widely differing communities and they are likely to have very different priorities. There is no solution that fits all.
Foundation hospital status, which was supposed to revolutionise the delivery of secondary healthcare, included a body of governors, elected by the local population, to oversee management. However, currently these governor bodies have finished up like convocations of eunuchs. For pity’s sake give them balls. MPs need to put our money and their promises where their mouths are.
WR positivity once associated with sexual indiscretion is today a widespread phenomenon in the developed world but related more to greed than to sexual promiscuity. Doctors should concentrate on saving life, reducing avoidable disasters, and trying to make poor health less of a burden for patients. At least that would go a long way to rendering us WR negative. The politicians need to let go of the reins of a subject which they barely understand. Money and medicine only relate to private practice. Consumerism has no place in the NHS.
- Main Doctors and managers – the Wayne Rooney syndrome? J R Soc Med 2010;103:478
- Aitken Geriatricians – a role reappraisal? J R Soc Med 2008;101:482- 483
- Aitken Do the British value continuity of care? J R Soc Med
- Department of Liberating the NHS: regulating healthcare providers – consultation on proposals. London: Department of Health; 2010. See http/www.dh.gov.uk/en/Consultations/Liveconsultations/DH 117782