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It’s Monday. You’ll have a to-do-list.
May I venture some advice?
Do the toughest job first. The job you least want to do… get it done.
You’ll feel better about the rest of the week and all the other jobs will seem easy and fall into place.
It is in the spirit of goodwill, I pass this advice on to you and… Wes Streeting.
His difficult job? You know what it is. Waiting lists. Very difficult. They're added to by about 50,000 people a week, winter’s coming and it’ll get more difficult.
Streeting’s suffering from task-aversion (to give it its proper name), and it's always bad. Waiting will simply become more overwhelming.
Streeting has a nasty case of ‘cognitive avoidance’. He'd rather find something easier to do… like announcing a consultation. He did it on Sunday. The press fell for it. He and the PM will be doing it again today.
The topics being consulted on include giving away smart watches to monitor health.
It’s a good idea.
D’ya know what… smart monitors were given to Parkinson’s patients, creating something called Parkinson’s Kinetigraphs. That’s been happening since 2022. Some diabetes patients have had smart devices… that started in 2019.
No consultation needed. Monitoring is a good idea.
The NHS could do much more… but you have to bring money and remember… every reading on every watch, in the end, will need a healthcare professional to figure out if it means anything sinister and what to do.
Consulting on preventing people getting sick in the first place?
Great idea, why not? But, don’t talk about going to a gym or not eating a chocolate muffin.
Take-on the food industry in the same way the Blair government took on the tobacco lobby to give us smoke-free environments and George Osborne took on the fizzy drink companies, to give us sugar reduced cola. Give us fat-free foods.
And…
… give us clean air, decent jobs, safe housing, family support, de-congested roads and a rounded education.
And…
… sort out the future of public health, marooned up the back passage of local councils, with no money and very little say.
Consult on a community based NHS? Why not?
Primary care led. We have it now. It’s called family practice. Mostly, it’s in walking distance from where we live. Over ninety percent of us make our first contact with the NHS via GPs who only get 11% of the budget.
Fix their budget and they’ll do more.
Do not give the kiss of life to Darzi Centres… herd all the GPs into one place and call them polyclinics, community NHS, NHS-Extra… whatever.
Don’t do it.
Gordon Brown tried. GPs hated them. They had to give up their premisses and there was no reimbursement mechanism. Big clinics fragmented services and inevitably involved mum pushing the buggy further and yer-granny struggling, to travel to get to them.
There's a difference between local, neighborhood and community... it's measured in bus-stops, kerbs, busy roads and crossings.
There were problems acquiring locations, (they can only be built where the NHS owns land) planning and building costs.
On top of that… what are they for?
Reducing the burden on hospitals? That means they have to do what hospitals do. That means duplication and double running costs.
The kit in a hospital gets duplicated in a polyclinic, as are many of the staff. Hospitals have fixed overheads and hospital FDs are left trying to run a Swiss Cheese operation.
High running costs made poly-clinics unviable and early evaluations showed no clear benefits in terms of outcomes or efficiencies.
Even McKinsey reported;
‘NHS managers had vastly overestimated the ability of polysystems to handle the shift in care from hospitals and revolutionise GP care’.
They cost more than they saved.
Countries that have polyclinics like Russia, Germany, China, Singapore and India don't have the fabulous, local, neighbourhood GP surgery networks that we have. (See the graphic below.)
There were fears polyclinics would be an ideal size and footprint to be run by the private sector and that caused a row that we could do without re-running.
They were such an unpopular and bad idea, the incoming Tory government and Andrew Lansley dumped them.
If Streeting needs ideas, here are three;
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Invest in primary care, basic family neighborhood practice and a lot of secondary care problems go away.
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Invest in social services, simple domiciliary care and lot of secondary care problems go away.
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Invest in jobs and housing and a lot of people will never come our way.
… and don’t put off the difficult job.
Seven and a half million people waiting, are depending on you.
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