Mitch Keamy is an anesthesiologist in Las Vegas Nevada
Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania
Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago
Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.
This is a very cogent and thought provoking news item about the NHS from the BBC:
http://www.bbc.co.uk/news/health-13130678
Wait times are at a 3 year high. Wait times, which correlate with patients seeking care, must of course vary over time, over days, weeks, months, and years. Everyone inside and outside the NHS is aware that its wait-times have been a patient-care issue and political football for a long time. So why is this news?
First, as demand increases and budgets are cut, extra funds that were once used to surge in times of increased demand are no longer available. The strategy of setting aside funds to respond to fluctuations in operational tempo was a very smart strategy for the NHS; it mimics supply-demand in a system that would otherwise be completely unresponsive to cycles in activity. As the budget problems in the NHS worsen, wait times, especially during upswings in demand, are certain to become worse than they are now. In short: less overtime = longer wait times.
As you would expect, there is a large gap between what independent (but not necessarily politically non-partisan) experts represent as the wait time and what they government reports. In this instance,the outsiders say that 15% of patients wait more than 18 weeks for specialty care, while the government claims that only around 10% do. This is a huge gap. Spin? Propaganda? Everyone knows that government agencies have an enormous incentive to represent their performance in the most favorable possible light. Over time, they can adopt methods for reporting data that are consistent, reproducable, precise, and completely divorced from reality. There are plenty of instances of this from the various levels of government in the US. Orwell could not have imagined someone like Baghdad Bob, or how statistics that translate into misery, suffering, and death can be transformed and reported by political agendas.
The other interesting part of the news item is that various trusts have very smartly decided to utilize clinical criteria to change the position of individual patients on a list. This is wise in that it accounts for details that no master-list schedule of criteria possibly could; it is hazardous in that it invites corruption and shennanigans en-masse. Absent a policy of random or comprehensive review, the pockets of the list-keepers will soon be lined with gold.
Within the NHS, there is intense interest in making the best of the substantial changes that are occurring. If I had the time and the money, I would attend this meeting:
http://www.hsj-patientexperience.com/
The lessons I might learn there could be helpful in years to come in the USA.
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