Saturday, October 06, 2007


1.3 million employees and less than 70,000 of them doctors. Blind Freddy could see what is wrong with that. But there are none so blind as those who will not see

Take a blank canvas. Talk to 1,500 NHS staff. Spend 12 weeks thinking hard. And then come up with the ideas you first thought of. That, in a nutshell, is a brutal but not inaccurate summary of the review of the NHS by Lord Darzi of Denham, published yesterday. Astonishingly, it identified as problems exactly the same things the Prime Minister and the Health Secretary have themselves been talking about for months: access to family doctors out of hours (Gordon Brown) and MRSA (Alan Johnson). Surely, in a system that now costs 90 billion a year, employs 1.3 million people and treats a million patients a day, Lord Darzi might have identified issues not already flagged up in a hundred tired political speeches?

To a tiny degree, he did. He correctly points out the glacial slowness of the NHS to adopt new ideas or buy into new technologies. He then goes on to propose the wrong solution, a centralised health innovation council to “champion” change. Such bodies have come and gone as swiftly as the dew on an autumn morning. Remember the NHS Modernisation Agency? Or the NHS Institute for Innovation and Improvement? (One of them is still around, not that you’d notice.) In a document that says local NHS organisations have the responsibility for change, Lord Darzi has proposed another top-down, London-based, all-the-usual-names body in a misguided attempt to impose it.

The NHS does not change because the incentives are not there. Managers who innovate take risks. If they go wrong, cost money, or produce headlines in the newspapers, the Department of Health can be relied upon to provide no backing. The trick of survival as a NHS manager is to change nothing and balance the books.

Lord Darzi also correctly identified stroke as a disease where the NHS has failed, miserably. He might have added allergy, liver diseases, osteoporosis or a host of other equally deserving conditions. The system is fundamentally unresponsive unless it is kicked. And kicking is no longer in fashion, so heaven knows how change will occur in future. His report also mentions health inequalities, which are widespread and growing. But both he and Alan Johnson appear to believe that such inequalities can be put right by a greater provision of healthcare.

Of course it is right that everybody should have roughly the same chance of seeing a GP. But evidence over many years shows that the actual provision of doctors has little impact on inequalities. In the new NHS, which is supposed to be evidence-based, Lord Darzi has ignored all this evidence, which points to the need for better education, nutrition and antenatal care, among other things. Instead we will have GP clinics open 12 hours a day, seven days a week, to satisfy the Prime Minister, while the gaps between rich and poor in expectation of life continue to widen.

Perhaps the most depressing thing of all is not what the report says, but the reaction to it. Almost all the great and the good who have backed every half-baked intitiative for the past decade emerged to say how pleased they were. Not only has the NHS stifled good healthcare; it has bought off those who are supposed to act as candid friends, and made them complicit in perpetuating its failures.


Australian Medical Assoc. backs better checks on foreign doctors

DOCTORS have backed a report which found under-qualified foreign medical practitioners are getting work in Australia because of inadequate checks of their credentials. The Monash University study found state and federal authorities were reluctant to require compulsory assessments of foreign doctors' qualifications and work histories, for fear of deterring them from coming to Australia.

Australian Medical Association (AMA) president Rosanna Capolingua said today she was not happy with the existing vetting of overseas-trained doctors' credentials. "We're not satisfied and we're very pleased to see the scrutiny that has come upon these processes," she said. "We've had a need for overseas-trained doctors for a long time and they've served us very well, but of late we've become aware of situations where the qualifications of doctors or their clinical skills ... have not been quite right."

The immigration department approves foreign doctors' visas, including character and security checks. But it is up to state medical boards and each doctor's recruitment agency - often a state health department - to ensure their work histories stack up. Dr Capolingua said health authorities were reluctant to conduct compulsory checks of qualifications, referees and work histories because it slowed the process of recruiting doctors. "It is variable - it's not done in some states," she said. "Some states do primary qualification verification, but it needs to be nationally consistent. What we find is if governments get involved, the imperative for them is to get doctors in. They are a little resistant to wanting to go through these processes."

She called for offshore screening to assess doctors before they come to Australia, as well as a clinical interview before they begin work. A senate inquiry last month called for urgent action to implement nationally consistent checking of overseas doctors' credentials to prevent a repeat of Queensland's scandal involving Indian-born Dr Jayant Patel. Dr Asif Ali, a colleague of former terrorism suspect Dr Mohamed Haneef, was sacked from his Gold Coast Hospital job earlier this year for giving misleading information on his CV.

Up to 37 per cent of GPs in rural areas are foreign-trained. Australia is significantly short of medical professionals and has turned to overseas-trained doctors to make up the shortfall, with 3000-4000 arriving each year.

Health Minister Tony Abbott today rejected suggestions that large numbers of incompetent foreign doctors were slipping into Australia. "If particular boards have approved particular doctors who people think are not adequately trained, well let people say which board has made that mistake and which doctor has been inadequately assessed," he said. Queensland Health Minister Stephen Robertson said overseas-trained doctors applying for work in his state faced the most stringent registration system in the world. [Ho, Ho!]


No comments: