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I applaud your recognition for better management. I don't think anyone would disagree with your logic about smart allocation of limited resources. That is, after all, what managers in the NHS are there for. (I was being a little flippant, when I said they were only there to manage budgets and targets.) Some are very good at their job. However, in terms of actual patient care, trying to manage individual cases through an unnecessary layer of bureaucracy, usually results in delayed treatment and increased costs.
It won't save a single penny towards the £20bn saving required. Both Scots and Welsh NHS are part of devolvement and so do not come under the "NHS" budget that the media talk about. It's why they have free scripts whilst England doesn't.
Worth noting that whilst they are getting those free both NHS Scot and Wales are having to find the money from another part of their budget.
I'd taken offence at that if I didn't think you were being flippant
This isn't what I do either. I don't decide where patients go, the GPs (and nurses/physios etc) have individual referring rights based on their clinical knowledge.
I don't allocate patients, I don't interrupt the referral process, I don't delay things. I *do* however pay the bills, I *do* point out to GPs that they seem to refer many more patients than their colleague and therefore the cost to the NHS of their actions is much higher (usually without benefit of fitter patients), I *do* make sure that we are getting what we are paying for and that someone isn't taking the piss... for example.
And yes, I make sure that targets are achieved because I think they are important. For some reason people have got the impression that a target exists purely to for the benefit of having a target to make managers happy. I'd happily lose all of them.
We never used to have them, before Labour. You know when people waited 36 hours on a trolley in an A&E corridor or waited 18 months just to get an outpatient appointment, then waited for an X-Ray then another 18 months to have their operation. Of people waited months to see a consultant in order to get a cancer diagnosis, during which time their tumour became inoperable.
Looking at the targets we have now, it's very difficult to see any which aren't driven by public expectation or by clinical need...
Scots don't get free scripts - they pay £3. They do however get free eye tests.
Where do you draw the line of this? Some people with epilepsy may injure themselves after having a fit - would they get the treatment for that for free?
I also realise that this money is divvied up by the Scottish and Welsh assemblies, but don't they get that money from England anyway....?
Examples:
Scotland - has the 18-week "referral to treatment" aka RTT (i.e. from GP appointment to operation) waiting time achieved by December next year
Wales - the RTT target is 95% of patients must have maximum wait of 26 weeks
England - maximum RTT for 100% of patients is 18 weeks and has been for a few years now. In fact it is a legal right for patients.
Doctor's discretion, I'd think.
Although the whole issue of the exempt conditions is a bit contentious, IMO. I'm not sure people should be exempt on the grounds of condition alone. How do you decide which illnesses qualify?
This is what I don't get either. I think with the exception of cancer, the exemptions were decided in the 1960s or something.