Err, why?

And, that NHS services should only be let out to private providers where there was no cherrypicking of routine cases – leaving the NHS with the cost of emergencies, complexities and post-operative catastrophes as well as training and research.

Haven\’t you ever heard of the division of labour? Specialisation?

What we would actually like is to have a system where the routine stuff was done over here, in as organised, mechanised, industrlaised, manner as possible, and the difficult stuff done over there.

Just as we already do in fact: wart removal is done by the GP, leg removal in an operating theatre with an anaethestist (spolling?), surgeon and team of nurses.

If a team set up to do nothing but hip replacements can crack through 15 a day, then we\’d rather like to have a team specialising in hip replacements rather than a general surgical team turning their hands to it once in a while and getting through 5 when they do.

We actually want to see the whole provision thing more fine grained: people specialising in certain tasks, where the division of labour increases productivity.

Keeping the NHS doing the non-routine stuff, the difficult stuff, is exactly what we do want to happen: getting others to cherry pick the simple stuff is similarly what we actually want to happen.

Blimey, this is actually the way that the entire medical profession is organised anyway, we don\’t get the ENT bloke to do ingrown toenails, the heart surgeon to do the brain surgery nor the schools nurse the leukaemia treatments. What the hell is this \”everyone must do everything\” nonsense?

2 thoughts on “Err, why?”

  1. “then we’d rather like to have a team specialising in hip replacements rather than a general surgical team turning their hands to it once in a while”

    Er, except that general surgeons don’t occasionally turn their hands to hip-replacements. For sure, the orthopods and the tummy-plumbers will get their heads together for some things (e.g. major trauma), but that’s as it should be.

    There are indeed dedicated centres (and many hospitals are organised as such e.g. neuro surgery), but your production-line vision of things is rather simplistic – intraoperative complications can occur in even the most minor op. Similary, an apparently straightforward procedure can be far more challenging in a patient with a high anaesthetic risk/extensive comorbidities. In my view, you should keep it all on base and plan for Murphy’s Law. Besides, it’s (yet another) false distinction to differentiate between what you call routine and non-routine – much emergency surgery is teh same skill-set. Indeed, these reforms have serious implications for workforce training and surgical “flying hours” .

    ISTCs certainly allowed the private sector to cherry-pick, leaving the NHS to shoulder risk/cost (and provide for re-admissions, or unplanned intensive care). IMO, these reforms will go further – and there will be even messier scenes than at present.

  2. “ISTCs” : If they are ready for unexpected “turns for the worst” and can handle such, then fine.
    There was a case recently where a non NHS surgical hospital continued with their paid cutting and stitching of whatever, when the patient went downhill fast. Outcome was not good.
    In an NHS hospital there would have been sufficient resources to cope without having to call an ambulance.

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