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If my SHA fell into a big hole in the ground…

Jobbing Doctor suggests a novel way of implementing cuts in the health budget.

The political noise is getting louder, and we are getting the fall-out from this in the health sector. The Government is laying out its assessment of the current financial woes of the country, and yet there is an elephant in the room that everyone is ignoring. This is because they don't want to frighten us before an election.

The elephant is still in the room, however, and that is in the form of significant spending cuts in the health budget.

I am looking at the health sector as I see it, a Jobbing Doctor practising medicine in the provinces.

The health budget has increased hugely in the last few years, and that increase has been beneficial. However, the spending has been a little like a blunderbuss firing at a target: some good outcomes have been achieved, but much of it has been decidedly missing getting the desired result.

I was musing on what might happen as I drove past our regional NHS centre last night in the rain. Firstly, I reflected on the fact that it used to be a hospital. Indeed the Jobbing Doctor did a locum Registrar job there in the seventies, and I remember doing my first sternal bone marrow aspirate there. Sigh!

In those days, a hospital had a clear function that everyone understood. People working there had defined roles, and there were uniforms and there were structures to allow the place to run smoothly. I knew my place, and - more importantly - the patients knew what to expect.

Now it is what used to be called a Strategic Health Authority, but recently has had (yet another) rebranding to change it from ‘My Region Strategic Health Authority' to ‘NHS My Region'. This is merely managers wanting to cash in on the remaining good will of the NHS as an organisation, and debasing it further.

So, I was sitting in a traffic jam in the rain, looking at the ‘NHS My Region' building, with the darkened rooms and the empty car park, and thinking what would happen if it all suddenly fell into a big hole in the ground.

The answer, I would suggest, is very little for a number of months. We wouldn't have meetings, or strategic documents, or reports or inspections or any number of other issues around administration. But I was thinking that they'd none of them be missed - by Jobbing Doctors, that is.

The lights changed, and I moved on to my choir practice.

I remembered it today, as I saw the politicians talking about cuts in the future, and these cuts including the health sector. All of the money could be saved, easily and painlessly, by abandoning the huge command and control systems put in place by Government. We could forget the high profile vanity projects, and could enact legislation to renegotiate PFI contracts to get value for money.

Any job with the title ‘Tsar', ‘Facilitator', ‘Co-ordinator' or (most ludicrously of all) ‘Champion' should immediately be removed. Much of the management could easily be stripped back to levels of the 1970s, where the average hospital administration department would be around 20 people.

In primary care, all the paraphernalia of the internal market could be immediately removed, and loss-making projects such as ISTCs and Darzi clinics should be closed down. The amazingly useless IT project could be scaled back, and we could start to turn Nurse Managers into Senior Nurses, and employ more medical laboratory scientists and physiotherapists and open more hospital beds.

This would be where the Jobbing Doctor would like to see ‘efficiency savings'.

Dream on, you old fool!

Jobbing Doctor