WHOM do we trust?
Bureaucrats and politicians? Or doctors and surgeons? We think you know the answer. But sometimes the easy, intuitive answer is not necessarily right. Television hospital soap operas always have the medics as heroes and the managers as villains, but real life is more complicated than that.
Perhaps neurosurgeons and cardiologists should concentrate on what they are good at, and allow managers to manage. In short, the findings of "strong dissatisfaction" among senior doctors about red tape and the role of managers is hardly surprising.
The NHS is the biggest corporate entity in the country, so it is hardly surprising that it requires managers. But the likelihood is that, when doctors complain, as they have done in a survey by researchers at Glasgow and Dundee universities, they are shooting the messengers.
Britain spends less of its GDP on health than many comparative nations. The fact that we waste much less than the US on complicated markets means we make scarce resources go further. But these resources are becoming more stretched. It is the nature of the beast. An ageing and more demanding population coupled with medical advances are bound to lead to tensions over resources.
We can see that in the pressures on accident and emergency admissions, in the related issue of bed blocking by the frail elderly who should not be in acute wards and in the waiting time pressures for elective procedures.
The convener of the BMA's Scottish consultants' committee, Dr Nikki Thompson, said the report commissioned by the committee revealed the "hopelessness" consultants feel if they are unable to speak out on behalf of patients and an "over-riding sense of frustration" about the important part political or financial priorities play in the decision-making process.
But political and financial priorities are at the heart of the process. That is a simple fact of life in an era of growing demand and finite resources. The question is: who is best placed to juggle these competing demands. A committee of competing consultants squabbling over scarce funding? Or well-trained managers who may not be much use with a scalpel or stethoscope but know how to manage limited resources?
Everyone agrees red tape and bureaucracy are bad things. The BMA found evidence of "strong dissatisfaction with the impact of non-clinical managers and bureaucracy in clinical matters".
There were also concerns that a "business-related rationale was seen to dominate decision-making rather than the rationale of medical professionalism, which consultants tended to equate with good patient care". We can share that concern, but ultimately, as Aneurin Bevin put it: "The language of priorities is the religion of socialism." We should look at ways of streamlining our NHS and trimming red tape, particularly when there are growing pressures to make finite resources stretch further.
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