UK Article on NHS

[Guest guest]

22nd September 2006

Hi again!

Having submitted a USA Report I read this newly published NHS Report from the

BMJ - just

released.

Perhaps we need to read this remembering the article a few weeks ago that

incorrect

prescribing in the NHS was commonplace.

Kind regards,

_____________

Saturday 23 September 2006

http://bmj.com/cgi/content/full/333/7569/0-f

Editor's choice

While Rome burns

Something strange is happening in the NHS. I don't mean the chaos of constant

policy

change, the threat of closures, the job losses, the financial crises-we are used

to all that.

No, I mean that although the service functions and patients are seen and

treated, many of

them satisfactorily, something important is quietly dying. I don't think it is

too fanciful to call

it the spirit of medical professionalism. And we, the medical profession, are

watching it die.

We asked Nigel Hawkes, an experienced health journalist, to give us his take on

the NHS

reforms (p 645). The result was unexpected. He describes a breathtaking ride

through the

past 15 years and concludes that, far from being privatised, medicine in England

has

become ever more a creature of the state. From the scrapping of the internal

market in the

early 1990s; through the NHS Plan in 2000; to the recent reinvention of the

internal market;

all that has really changed, he says, is who does the kicking and who is kicked.

Increasingly

centralised decision making, driven by a political imperative for constant

reform, has left us

victim to " a patchwork of mutually contradictory ideas struggling for

dominance. "

You can see the appeal of centralised decision making, but it leaves no scope

for regional

experimentation and diffusion of best practice. And although medicine has

embraced the

need for evidence based medicine, policy making remains largely an evidence-free

zone.

Hawkes voices the policy makers' justification: if health reforms needed proving

before they

were tried, nothing would ever get done. But even some evidence would be a

start. In his

personal view (p 661), Lehman decries the lack of debate about the

proposed

hospital closures announced by the NHS's new chief executive last week (p 617).

It is, he

says " the personal responsibility of our professional leadership to mark out

where the

evidence lies, what it says, and what it is lacking. "

But where is our leadership? And where, asks Ian Greener, are the voices raised

in protest

against the breakdown of Aneuran Bevan's founding concordat: that the government

would

fund the health service but leave its operational running to the doctors (p

660). " The

government has found ways to interfere in medical practice on a remarkable

scale, " he

writes. In the absence of coherent protest we might conclude that doctors have

once more

had their mouths stuffed with gold or that the medical profession wholeheartedly

approves

of the government's reforms. However, the most likely reason is more worrying

still, as

Greener agrees: that most doctors no longer have the will or power to stop the

reforms.

If the government isn't listening, can the medical profession make it listen? We

must, if our

professional integrity is to be salvaged. Whether through established bodies

(the BMA, the

colleges, the large medical institutions) or through non-aligned groups led by

inspired

mavericks (the Cochrane Collaboration might serve as a model), the message to

policy

makers must be " stop, consult, and look at the evidence. "

Fiona Godlee, editor