Audit commission told to butt out of the NHS
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"anton" antonr...@SPAMbtinternet.com
The Audit Commission were unwise enough to point out that NHS waiting lists were being fiddled, and (implicitly) that ministers connived at these lies.
Amidst the fanfare of trumpets with which Brown has announced the "independent" commission to inspect the NHS, the Audit Commission is being told that the NHS will in future be off limits. Or rather, that the "Commission for Healthcare Audit and Inspection", staffed by another bunch of Tony's mates, will now shoulder the responsibility. Anyone care to bet on the chances of a CHAI report ever criticising Labour fiddles in the future?
What a bunch of scum we're ruled by.
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Anton
alanG lan.g...@ntlworld.com
On Fri, 19 Apr 2002 16:28:39 +0000 (UTC), "anton" They learned a lot of the tories didn't they.
Meet Tony son of Maggie.
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Alan G The rule of law 'excludes the idea of any exemption of officials or others from the duty of obedience to the law which governs other citizens or from the jurisdiction of the ordinary tribunals' (Dicey)
"Wolf" andrew.w...@ntlworld.com
I don't think so.
This government has rightly lined up setting the right targets ("a good service") with measures of performance (deliver it) Unfortunately it doesn't trust anyone to actually do it, or indeed to fail trying in public, so the scoreboard must be fixed.
Most of the failures are due not to managers but to the medical profession being unwilling to buy into the priorities of the public who pay their salaries. And the government - both parties - have no way of dealing with the ultimate trade unions - the BMA and the Royal Colleges.
I don't think this is party political - most doctors, in my experience, are Tories.
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"Steve Glynn" stevegl...@ntlworld.com
But it's not the doctors who fiddle the waiting lists (if they are fiddled).
It's the hospital trusts and administrators, and they've got every incentive so to do (as they did under the previous government's set of priorities) because of league tables, finacial incentives for hitting your targets and penalties for exceeding them.
Whichever way you organise it, any system of targets skews clinical priorities. If the hospital has to make sure no one waits more than however long it is for a hip replacement if it wants to avoid penalties and bad publicity, then the fact that Mr Smith had better have his hip done within the next fortnight becomes a powerful consideration. Which is all very well, but if you haven't incentivised heart surgery, there's an immense pressure to postpone Mr Jones' heart op, because he'll probably be OK if you don't operate for a month, but it would clearly be preferable to operate as soon as possible.
That's a genuine example given me by a consultant reumatologist, btw.
While he was obviously pleased that his patients were getting their hip replacements, he felt genuinely uncomfortable that this was delaying operations for other patients whose clinical needs he felt were more urgent.
Similarly, if you guarantee that everyone referred to a consultant in a particular specialism will be seen within a certain time, that's all to the good. However, this provides a strong incentive to concentrate resources on this particular specialism.
A year or so ago my wife was referred for a consultation with a neurologist, partly to confirm the GP's diagnosis, and partly (which the GP didn't say at the time, but I realised, and the GP later confirmed) to rule out the possibility that the symptoms were caused by something very nasty indeed.
The GP said she couldn't start any treatment until she'd heard what the neurologist had to say, though she was certain her own mind what the problem was, partly because the drugs she'd need to prescribe to control the condition (which, thank God, was epilepsy rather than a brain tumour) have pretty powerful side-effects, and she wanted expert advice on which ones and at what level she should prescribe.
You can imagine my reaction when my wife was offered an appointment in 10 months' time. Quite apart from the fact we didn't want to wait that long before starting to control the seizures, she'd have been dead before then if it had been a brain tumour, for God's sake. The GP was furious, and my MP wasn't too impressed either (he got a much earlier appointment arranged).
He was even less impressed -- he's Labour, btw -- when he discovered that the reason for the unacceptable wait was that our large local hospital shared the services of one consultant neurologist part time with another large hospital in the area. He did tell me roughly how many people the two serve between them, but I can't remember offhand. About half of Warwickshire, anyway.
Being a good guy (and not wanting potential voters killed) he asked the hospital trusts concerned what the hell they thought they were playing at, and discovered that it was his own lot's fault, since as there was no target for how long it should take to see a neurologist, a lot more effort and money naturally went into recruiting people there was a target to see. (He did actually manage to get some extra money from the DoH for them to fund another neurologist, thus going to prove that MPs can sometimes be useful).
Both, I think, are pretty clear examples of the way targets distort things in the NHS (and most public services).
They're based on a false model. In commerce, they make sense -- sales targets, targets of market share, customer satisfaction, etc -- but in the public services they don't.
If you were a Chief Constable, and knew that your funding and probably your career prospects depended on the clear-up rate in your area, wouldn't you be tempted to concentrate on those crimes that are easy to clear up and neglect the ones that aren't?
If you were a Head Teacher, and knew that a lot depended on the GCSE p*** rate at your school, wouldn't you be tempted to encourage your pupils to go for the easier subjects? And if you ran an examinations board -- of which there are several, which compete on a commercial basis -- might you not just be tempted to make sure your papers were that little bit easier than those of the competition (who, of course, would be tempted to make theirs even easier than yours)?
Steve
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"anton" antonr...@SPAMbtinternet.com
..but you don't give even one example. Unimpressive.
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Anton
"Dan Scorpio" BobSo...@hotmail.com
An excellent appraisal of some of the means used by the dark forces to divert, obfuscate and ultimately mislead opinion. '...lies, damned lies and statistics.' When using measures, particularly of the spurious 'league table' type, those suitably placed to select WHAT is to be measured have a marvellous opportunity to direct and focus attention, and thus debate, which they use as surely as the wily conjurer in the bunco booth misleads and misdirects with his smooth patter and sleight of hand.
When we measure, we must very carefully decide WHY, WHAT, WHEN and HOW we measure - and these decisions are often political in nature, even in the supposedly 'objective' world of science. to measure how efficiently the pumps expelled the water from the hull of the ailing 'Titanic' is to completely miss the point.
Huxley recognised the importance of the selection of appropriate symbolisation and its deterministic effect in thinking as one of the most significant problems facing mankind: 'Consider, for example, the domain of science on the one hand, the domain of politics and religion on the other. Thinking in terms of, and acting in response to one set of symbols, we have come, in some small measure, to understand and control the elementary forces of nature. Thinking in terms of, and acting in response to, another set of symbols, we use these forces as instruments of m*** murder and collective suicide. In the first case the symbols were well chosen, carefully analysed and progressively adapted to the emergent facts of physical existence. In the second case symbols originally ill-chosen were never subjected to thorough-going analysis and never re-formulated so as to harmonise with the emergent facts of human existence. Worse still, these misleading symbols were everywhere treated with a wholly unwarranted respect, as though, in some mysterious way, they were more real than the realities. In the contexts of religion and politics, words are not regarded as standing, rather inadequately, for things and events; on the contrary, things and events are regarded as particular illustrations of words.' [Aldous Huxley: foreword to Krishnamurti's 'First and LastFreedom']
"Wolf" andrew.w...@ntlworld.com
"Whichever way you organise it, any system of targets skews clinical priorities. " <snip> Medical mafia mumbo jumbo.
These are a selection of current Health service targets. Which of the targets listed below "skew clinical priorities"?
Is speeding up cancer treatment "skewing clinical priorities"? Is seeing a GP within two days unimportant?
Is getting you an ambulance if priority need within 8 minutes a distortion of clinical priority?
Doctors treat both urgent and non-urgent patients all the time. They grumble constantly about clinical priorities but they accept non-urgent patients and complain they then have to treat them, eventually.
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Selection from Targets for Health Service performance 2003 90% of patients to spend no more than 4 hours in A&E from arrival to admission, transfer or discharge.
ambulance Trusts to meet the target to respond to 75% of Category A calls within 8 minutes Ensure 90% of patients who wish to do so can see a primary health care professional within 1 working day and a GP within 2 working days by March 2003.
Achieve a maximum wait of 5 months (21 weeks) for an outpatient appointment Achieve a maximum wait of 21 weeks - total number of outpatients waiting over 21 weeks.
Achieve a maximum wait of 12 months for all inpatient waiters Where a patient's operation is cancelled on the day, the Trust will arrange to admit the patient within 28 days. If this is not possible the patient will be offered the option of treatment at a hospital of their choice.
a maximum two month wait from urgent GP referral to treatment for breast cancer, Deliver on existing maximum waits (two weeks for a first outpatient appointment for suspected cancers; one month from referral to treatment for testicular cancer, acute leukaemia and children's cancers) ensure all patients receive the clinically proven and cost effective drugs they need, taking full account of NICE appraisals of chemotherapy and smoking drugs and the views of individual patients about their treatments.
support roll out of action on a healthy diet particularly targeting deprived areas, including the planned 50 new Five-a Day community initiatives and the expansion of the school fruit scheme to cover 600,000 children.
Ensure 75% of eligible patients receive thrombolysis within 20 minutes of arrival at hospital by April 2003.
Cut waiting times for CHD at all stages of the patient journey: in an emergency, through maximum 2 week waits for rapid access chest pain clinics by April 2003; and through falling waits for diagnostic angiography and for revascularisation.
Cut waiting times for CHD at all stages of the patient journey: through falling waits for diagnostic angiography and for revascularisation.
Expand revascularisation capacity to maintain and improve on a 12 months maximum wait so that a growing number of patients are treated within 9 months.
introduce choice of alternative provider for patients who have waited 6 months for revascularisation at their current provider.
Reduce the number of acute beds blocked by delayed discharge by 20% (around 1,000 beds) by March 2003, compared with April 2002.
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alanG lan.g...@ntlworld.com
On Sat, 20 Apr 2002 06:22:25 +0000 (UTC), "anton" National statistics employees made public tory fiddles of unemployment stats. Impossible to know the real unemployment figures for the mid 80's now.
You want more you find it but you wont look cos you think the sun shines out that bithches arse.
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Alan G The rule of law 'excludes the idea of any exemption of officials or others from the duty of obedience to the law which governs other citizens or from the jurisdiction of the ordinary tribunals' (Dicey)
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