That Kafkaesque NHS again
nick cowen, 28 March 2007
Dr Crippen delivers a steady drip feed of episodes that demonstrate quite how ridiculous and dangerous hospital bureaucracy has become. This diary entry from yesterday was exemplary.
Tuesday 27th March
One of those irritating but glorious phone calls.
I saw Mrs Jones, a middle aged lady, and heavy smoker, with an ominous lump in her neck last week and, after a few routine tests, referred her urgently to ENT. She called this morning to say that she had been phoned by the hospital to say that they could not see her until they had had a letter from her GP. Had I sent the letter? I confirmed I had sent it both by post and by fax. Well, they say they won’t see me without a letter, and they have not received it. Are you sure you sent it? It was clear she did not believe me.
I said, Mrs Jones, please, think about it. How does the hospital know that you need an appointment if they have not received my letter?
Ah!
The current scandal hitting the headlines centres on dentistry. This morning, the Today program treated us to Health Minister Rosie Winterton trying to excuse the government’s failure to provide a reasonable level of dentistry to every region after 10 years in power. Large ‘dentistry deserts’ lack any NHS coverage at all and those unable to go private simply do without. A new contract which stipulates exactly how much NHS work a dentist is required (or rather allowed) to do has lead to practices fulfilling their contract early and closing the door to new patients altogether.
Winterton tried several explanations. She said that the new contracts were based on the work done by dentists in the previous year (with a 5% reduction in return for dentists giving patients preventative treatment more frequently) suggesting that the increased demand could not have been predicted. This cheerfully ignored the widespread shortage of dentistry last year. So telling dentists to do roughly the same work this year as last year would carry over roughly the same shortage! Next she claimed that the problem was the lack of planning by the dentists themselves. The problem is apparently not that demand for dental work is greater than the supply, but rather that dentists have been simply working too quickly! When a patient has turned up with a toothache, they have treated them immediately. Which simply won’t do in a planned system where a carefully rationed amount of treatment must be spread out month by month!
The final response was that even if there is a problem, it is not the government but the local Primary Care Trusts that are responsible. But what choice do PCTs have when both their annual funding and their contracts with dentist practices have been agreed centrally? If the funding doesn’t fulfil healthcare demands then some aspects (or more often, all aspects) of local health provision will have to suffer. Leaving PCTs to make only the decisions that the government refuses to does not make the government any less responsible for this mess.