Britain’s health secretary wants to uncharm his way to a revolution.
To galvanize support for a seven-day National Health Service (NHS), which the NHS was before Jeremy Hunt’s radical plans, and still is, he asserted that thousands die because there is a shortage of senior doctors during weekends. This is an expedient interpretation of a study which showed that mortality was higher in patients admitted on weekends. Hunt ignored the fact that patients admitted on Friday night are actually sicker than those admitted on Wednesday morning.
When logos failed, and after briefly dabbling with pathos, Hunt resorted to ethos. He insinuated that doctors were clock watchers. (“Service that cranks up on a Monday morning and starts to wind down after lunch on a Friday.”) This led to a hashtag on Twitter:#ImInWorkJeremy.
Hunt wants to modernize the NHS. Leaving aside whether modernization is modernization, postmodernization or pre-post-pre-modernization, presumably this endeavor benefits from having doctors on board. How has Hunt enticed the doctors? He prophesized that GP’s diagnostic skills could be obsolete in twenty years. He wanted to replace doctor’s clinical judgment with computers, sooner rather than later. (He’d just returned from Silicon Valley.)
Karl Marx rallied workers to fight machines and capitalists. Hunt’s approach is of a middle manager with a touch of Mahatma Gandhi. “You suck. The computer will replace you. Do you mind hastening your replacement by embracing the machine, preferably without breaking the screen? Thank you, kindly.”
Junior doctors are leaving the NHS in droves. Many serve Australia’s areas of need, such as Mount Isa in Queensland. This allows homegrown Aussie doctors to stay in Melbourne, and intrepid Aussie doctors to move to Sydney. Britain’s taxpayers are subsidizing the Australian healthcare, just as the taxpayers from the Indian sub-continent once sustained the NHS.
Hunt, tackling the issue with Kissinger’s diplomacy, offered junior doctors a stick with no sight of a carrot. He wants them to work harder for less pay. In return? There are certain things money can’t buy.
History will unlikely judge Jeremy Hunt as the heir to Machiavelli. To be fair, neither is he the heir to Slytherin. He is Ebenezer Scrooge’s fastidious accountant. He wants the NHS to deliver as much as possible with little investing. He’d be a handy companion if backpacking in Thailand on a shoestring budget. Until he embarrasses you at the Hilton by refusing to pay for the premium scotch.
Hunt is in awe of Virginia Mason Hospital in Seattle, although I am uncertain he will import their entire business model to the NHS. He wants American health care at NHS prices. He dreams globally and pays locally.
Hunt suffers from austeritis; he wants the political gains of austerity without the political losses of austerity. He wants his austerity and not have to eat it. His method, uniquely British Conservative: Pay less and demonize the workers, once worked in Stalin’s Soviet Union.
There is a chasm between doctors and Jeremy Hunt. Doctors think Hunt is a pantomime villain. This is unfortunate, not only for pantomime villains. The NHS has different issues today. Britain has changed. When the NHS was born, Brits were resilient, and the Daily Mail did not have an online comment box to vent. There were fewer permutations by which death could be deferred marginally. There was tuberculosis. People were grappling with the harms of smoking. And people were told to eat an apple, not a statin, a day.
Furthermore, the emergency department (ED), or whatever it was called then, wasn’t a one-stop shop after Saturday night partying. NHS’s crisis is an ED crisis. The ED crisis is a societal crisis. The crisis has been caused, partly, by four-hour targets, which forced the ED to see patients, regardless of the chronicity or absurdity of their symptoms, as soon as possible.
I once worked in an inner city ED with nurses so good that they gave doctors a run for their money in clinical acumen. The nurses triaged and triaged liberally, making some with long-standing symptoms wait eight hours to be seen, all the while ensuring that myocardial infarction was seen instantly.
The eight-hour wait time persuaded the thirty year old with vague belly pain for six months to see his GP. Everyone in the U.K. has a GP. Everyone. It is their right. The “right to a GP” has become a “right to a GP at my beck and call.” Hunt wants this right guaranteed at no surcharge.
Breeding unfettered consumerism and social justice creates disingenuous public policies. The public wants 24/7 concierge doctors without forking out the dosh. Who would say no to that? Hunt, instead of confronting this arithmetic delusion with honesty, is fanning it.
NHS is the art of the impossible. If Jeremy Hunt was less patronizing, and gave doctors due credit that they can add and subtract, they will deliver more than the impossible.
Instead he, like those before him, has gone for the jugular. Bringing doctors down a notch won’t modernize the NHS. Hunt’s strategy is penny foolish and pound retarded. If doctors abandon the clinical judgment that Hunt so belittles, austerity will be an imaginary number.
Saurabh Jha is a radiologist and can be reached on Twitter @RogueRad. This article originally appeared in the Health Care Blog.
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