Britain’s National Health Service is becoming less Centralized to Improve Quality

Posted by PITHOCRATES - March 31st, 2013

Week in Review

The answer in fixing the American health care system, according to Obamacare, is for more top-down management.  A centralization of the health care system.  Having distant bureaucrats make treatment decisions for patients.  Why?  According to President Obama, doctors were ordering needless tests and procedures just to maximize their billings.  The president even said they were amputating limbs unnecessarily.  Again, to maximize their billings.  And the only way to stop that was with the heavy hand of government.  Just like they do in Britain (see Hospitals that fail patients will be fined, says NHS chief by Denis Campbell posted 3/29/2013 on the guardian).

Hospitals will face financial penalties if they fail to give patients with problems such as a stroke or heart attack the best possible care, under controversial plans spelled out by the NHS’s top doctor.

Professor Sir Bruce Keogh, speaking to the Guardian, said the new GP-led clinical commissioning groups (CCGs) that will take control of £65bn of health spending on Monday will hold back from a hospital part of the fees for an operation if the patient has not been treated to the highest possible standards. “The idea is that the CCG would say: ‘We will withhold a certain amount of payment from you until you can demonstrate that you’ve met these standards.’ So it’s a bit like the building industry – you pay 90% of the [cost of] the building upfront, and then the final payments comes a bit later, when you’re sure everything is OK,” Keogh said in his only interview before the new NHS system starts in England on 1 April.

Such differential payments – it is hoped – will compel hospitals to provide high-quality care and force units that do not embrace the latest medical thinking in their specialism to overhaul what they do. Medical teams that do not implement the latest clinical guidance – called quality standards – on how to manage those with a particular condition will forfeit an as yet to be agreed part of the payment…

His tough message to hospitals on quality of care was reinforced by the decision late on Thursday to suspend children’s heart surgery in Leeds General Infirmary following concerns about the quality of lifesaving procedures offered there and the number of its patients who died. An inquiry into practice at LGI has begun…

The NHS Confederation, which represents hospitals, voiced unease at the plan. It would be better to give high-performing hospitals small bonuses over and above the full tariff rather than use penalties against the weaker ones, said Mike Farrar, its chief executive and a former boss of the NHS’s north-west region.

“Bruce is right that commissioners [CCGs] need to use levers. But the downside of penalties is that if hospitals don’t reach the standards set, then they don’t get the rest of the tariff fee and the risk is of a downward spiral in which they have less resources next year in which to try and meet the standards,” Farrar said.

In the Guardian interview Keogh urged the NHS to help stick to its tight spending limits by cracking down on patients receiving unnecessary tests and procedures – known as “overtreatment”.

He voiced concern that the NHS is conducting too many x-rays and blood tests without a good medical reason, subjecting some patients to operations they do not need, and prescribing too many antibiotics.

Odd.  The very things a more top-down approach was supposed to eliminate are now being eliminated by moving away from that top-down approach.  And moving towards a more local approach.  Having people closer to the patients making treatment decisions.  Holding caregivers accountable before they authorize final payment for their services.  And making sure patients and their families are satisfied with the care they received.

Almost sounds like a step back to that intimate doctor-patient relationship.  That served patients so well.  And doctors.  For the only way for doctors to get rich was by taking care of their patients as if they were family.  So they wouldn’t go to another doctor.  And form an intimate doctor-patient relationship there.  Providing a strong incentive to give patients the best care possible.  Because there was accountability.  Not a cold, faceless bureaucracy.

Those on the left have long pointed to Britain’s National Health Service (NHS) as the proper way to do health care.  And here they are.  Moving towards the way things were in America.  Before Obamacare.  Basically a tantamount admission by someone in the business of national health care that it doesn’t work.  And yet here we are in the United States.  Moving towards something with a proven track record of failure.  Something that will benefit the politicians.  At the expense of the patient.

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