Thursday, 16 February 2012

Carwyn could do better setting aside ...

... the baggage of "only public service allowed", it just doesn't fit with life in the 21st century, a life that should be a reflection of the following letter in today's Times :

Sir, As head of radiology at a Glasgow teaching hospital for 23 years, I was very much in the front line of financial problems. Of course the NHS has been a success, much loved by the British public. But it is a huge monster devouring every penny it gets. The service could be fitter and slimmer.

On retirement, when working in Sydney, I was most impressed with the emphasis on service. All staff realised that they were in competition with other groups; the practice income and their pay depended on the quality of their service. Patients were examined that day or the next and left with a typed report — no delays for CT scans. Indeed, seeing the need for a scanner this group arranged its own funding; no need for endless time-consuming committees and layers of bureaucracy.

Patients were covered mainly by State insurance, some privately. If the practice did well, the income increased and staff were better paid. No obscure “Clinical Excellence” Awards there. Not only that, the practice handled a workload similar to that of UK hospitals but with fewer staff and a better service.
We must get away from political dogma — enterprise, ability and good service at all grades must be rewarded. Whatever else, the founding principles of the NHS must be preserved, free healthcare for all based on clinical need. Dr J.K.Davidson Glasgow Sir, Ian Rogers (letter, Feb 14) suggests that Clinical Excellence Awards for senior doctors should be scrapped because “hospital doctors undertaking the same responsibilities and workload should receive the same payment”. ............ letter in full £
Dr Andrew Bamji, Rye, E Sussex 
How might the experiences of Dr Bamji be applied to the NHS in Wales ?

Over the last 6 months or more I have had a very personal and direct association with our NHS doctors surgery (practice) and our local Health Board (Aneurin Bevan), what have I learned ?
The story...

Initially the practice diagnosed a probable meniscus tear to the left knee although I was told it could be arthritic, I had an x-ray within two weeks, followed by an MRI scan two weeks later, and an appointment with the consultant surgeon two weeks following.

At the appointment with the surgeon he was surprised that both x-ray and MRI scan results were in his hands, he explained that it was usual for the diagnostics to be requested by him, our practice had cut 6 to 8 weeks from the period of diagnosis.

Things got a little complicated, after a week off work the company I work for convinced me to return to work (light duties), this was probably a mistake, the pain at times when I was in the warehouse was pretty bad, some of the staff can be a problem which puts me on my feet and walking.  I was losing condition, muscle, I put it down to the knee pain.  During a visit to family during October, my sister in law commented that I "looked frail", not an expression I had heard before, it played on my mind.  Worried I visited the practice, not many questions asked, none to do with the knee, answers "Yes" to each question, the doctor smiled at me and said "join the club, its a royal club, you have diabetes".  There followed a week of tests and the first diagnosis that I had Type II diabetes.  During the following month medication and diet was modified until it seemed my Blood Glucose had stabilised.

The diagnosis was important to me, but unknowingly it would set back treatment for the knee.  Mid November a letter arrived to attend a Pre-Admission Clinic for knee surgery, happy days, not so happy, the newly diagnosed diabetes would put back surgery until such time that both my diabetic medication and Blood Glucose had stabilised.

During November and December we worked on the diet so as not to need further modifications to the medication, by early January I felt everything was looking good, so booked an appointment to see the diabetic nurse who arranged for a series of tests to confirm my feelings, I was right but it was better than my feelings, cholesterol both good and bad had dropped to normal readings, my 3 month average Blood Glucose was better than my readings (better test).  An angel, she was straight on the phone and followed everything up to the surgeons team by letter, a week later a letter of appointment arrived for 26th Jan, it was just a test for nasties the surgical team preferred not to come into their theatres.  A couple of days later a letter for surgery 3rd February.
How does my little tale help Carwyn, well, it could be any business dealing with departments, but it is also a description of a business dealing with another business['s], in my case 3 [4 including post operative therapy] enterprises...
  • General Practice
  • Diagnostic services
  • Surgery
  • Therapeutic services ()
 At present the departments are evaluated through politically set targets, what do politicians or their familiars know of the realities of medical process.

Dr Bamji might offer Carwyn the benefits of his experiences in Australia as it might be applied to Wales, Carwyn might also consider the need to devolve tax raising powers for health to give greater control, he might convince the voters to contribute more, Carwyn might consider the need to devolve wages to NHS businesses, not to cut salaries, but to enable salaries to rise in the wake of greater customer satisfaction, and a by-product of that satisfaction, greater productivity.

Just thoughts ........

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