The IBMS
have published
their response to Lord Darzi’s review of the NHS. I’m reminded of my
grandmother listening to a cousin jabbering on at great length loudly and ostentatiously
about the failings of the committee of the local fishing club whilst doing
nothing himself other than sitting on his bum and finding fault. Gran listened
patiently, then announced “fine words butter no parsnips” and this is
true of both what Lord Darzi has found and the IBMS’s response.
Lord
Darzi’s report highlights the rising number of people living with multiple
long-term conditions and the strain this places on hospitals. To address these
challenges he says that immediate action and a strengthened diagnostic
infrastructure are needed to ensure early detection, continuous monitoring, and
better management of chronic diseases.
Can’t
disagree there.
He goes
on to say that a shift in focus from hospitals to community-based care is
essential, and expanding the reach of diagnostics into community settings will
enable earlier interventions and reduce pressure on hospitals.
We can’t
argue with that in theory, can we?
But in
practice? Lord Darzi has done reviews of the NHS before. He feels (probably
rightly) that the NHS is too big, and would work better in smaller units.
However at the time pathology service were reviewed by Lord Carter of Coles and
he said “big is better”.
It’s no
secret that path labs struggle to recruit. It wasn’t that long ago that an NHS
Trust not a million miles away from where I live was seriously considering
closing one of its three laboratories because it (probably) had enough
staff to run two labs, but three was a stretch.
And look
at today’s trend for pathology networks in which individual labs are reducing
their test repertoire and centralizing tests for economies of scale.
If Lord
Darzi wants diagnostic testing out in the community and a massive increase in
point of care testing he needs to staff it. So he can either de-skill the
workforce, and we all saw what a shambles that was (on national TV!), or
he can recruit a *lot* more biomedical scientists. And he can only do
that by making the job more attractive. And that will cost.
Having said
(ranted) that, personally I’m taking whatever Lord Darzi has to say with
a pinch of salt. Whatever he says simply won’t happen. At the risk of appearing
to be an old reactionary, I really have seen it all before. Many times.
There
will be all sorts of meetings at the Department of Health. Meetings, meetings
about meetings that have happened. Meetings about meetings that are to happen.
Eventually NHS Trusts will get orders from these meetings… and at that very
point where something might actually happen, Lord Darzi’s ideas will be
superceded by the next great NHS shake-up.
Look at
what Lord Darzi is suggesting… he feels that (effectively) community-based
care will call the shots in the NHS. That’s been done before (at least twice)
and abandoned both times because of political ideology rather than any tangible
evidence.
What the
NHS needs is a load more money to recruit and train staff. And having recruited
and trained staff it needs to be left alone for whatever current review and
shake-up to take effect. Then this current review and shake-up needs to be
formally reviewed and assessed, and fine-tuned on the strength of verifiable
objective data, not the whim of whatever politician is in vogue at the time.
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