I assume you are not referring to the many many office managers. In my own health authority the amount of strange titled jobs has increased year on year but of course they have to fill one of the most expensive office blocks in the city that the health board now rents. I have though many Freedom of Information requests discovered that my helth authority has wasted millions of pounds on various ill thought out projects mainly IT systems that cannot talk to other systems within a single hospital let alone other departments throughout the the board. Millions of pounds on computers which can be found lying idle in virtually every room I have been in in various hospitals. Another example of the wanton waste was NHS Lothian's decision to rename the Complaints Department to the Customer Relations and Feedback Team which has been derided not only because when did patients within the NHS become customers? And the amount of money that was spent on consultants and re branding or reprinting all the booklets brochures ETC. Yet some wards, like the cancer ward I was on for chemo were woefully under staffed. It is all about priorities and my particular health board seems to far to many chiefs and not enough indians. And the indians they do have and I am referring to the consultants all seem to work part time for the NHS the rest of the time are spent working for a private medical company, Spires being the company of choice. Perhaps if they spent more time working for the NHS then I would not have had to wait 7 weeks for a result of a biopsy recently with the excuse given for the long wait that as there was no malignancy then the consultant did not see any need for urgency, it did not seem to matter to him that as a previous cancer patient then I was likely to be a tad concerned. Whether my health board is just poor or this is the standard throughout it is not helped, as you said, by successive governments trying to 'change things for the better'
Yup, there's poor management as there is everywhere. People are not evil, but they are also not necessarily very competent, are often trying to meet banal, conflicting and double-bind objectives dreamt up by out-of-touch politicians on too little resources and all are desperate to keep their own job first because they have mortgages to pay and kids to feed. Every institution or organisation by its nature develops the properties of a tribe or life form and starts striving to maintain it own existence. Intel doesn't strive to make chips; Intel strives to ensure its continued existence. It just happens to do that in part by making chips (but also by doing lots of other things that have little to do with actually making chips). The NHS is the same. It was created to deliver health care, but consisting of people whose livelihood depends on the continued existence of the NHS, on another level it also acts simply to preserve itself. As such it may engage in practices that have little to do with patients or their health care directly. But every institution or organisation works like that, and every subdivision within it (see Microsoft for a nice example). Every single one, whether governmental, charitable or commercial. It is a fundamental emergent property of what institutions and organisations are. We had good stuff: we had the National Cancer Action Team and the local Cancer Networks, which actually had real power and influence to set national minimum standards for cancer care and make sure that Trusts adhered to them (I was part of one, and I co-wrote some of those standards). Then the Tory-Lib government came into power, and they disbanded NCAT and the Cancer Networks. Now we have no quality control over cancer care whatsoever. I worry deeply about this, and so do many oncologists and cancer nurses. If the NHS paid those consultants to work full-time for the NHS, then perhaps they would. But like myself they are often on part posts. I look at some of my privately employed colleagues: they work in nice, new buildings with nice offices and appropriate clinical space and their own on-site parking, but they have their own problems to deal with --it's a commercial business after all, and if you think that the NHS is bad, wait until you get a load of the way they do business in private health. It's frankly worrisome. I firmly believe in the principles of the NHS; I choose to work for it even though I'd probably earn significantly more in private practice. But then the patients who need me most would not be able to afford me (and I can't work for free; I too have a mortgage to pay). But I suspect that's where I will end up in the long term. I suspect that in ten years NHS care provision will be privatised, and we will have no choice at all.
In my health authority they are still paid well with a substantial bonus at the end of the year no matter how many complaints have been raised against a particular consultant. As you say "they work in nice, new buildings with nice offices and appropriate clinical space and their own on-site parking." They also have lovely profile pages listing all there qualifications, experience in their fields of interest ETC ETC. The amount of information was they posted was extremely useful when I asked why a certain consultant indicated that a particular interest of his was swallow difficulties following radiation therapy to the neck, yet showed not a bit of concern in to my problems which have since resulted in me being permanently unable to swallow solid food. 5 years later I still await a satisfactory response to this question. I have never been particularly supportive of the NHS, I was married to a student nurse some 35 years ago and the treatment of her was appalling whilst training. she would on occasion come home crying because of the amount of responsibility placed on her during night shifts. But I have been fortunate that up to my cancer I have never had any hospital treatment except for the odd A&E whilst in the building trade. But my experience of the overall treatment and support with my potentially life threatening condition has left me deeply concerned about becoming seriously ill in the future if it meant I had to be admitted to hospital, well one particular hospital. I know of a consultant that is also deeply concerned and has not been afraid to speak out, but was, to put it bluntly, told to shut up. One of the few consultants I actually trust. He really feels that the target driven care has cause many services, particularly with cancer care to have suffered. With patients being told we have 'cured' you now p*** off, with very little after care. Even during treatment I was constantly told if I had issues in the first instance consult my GP. Now I have a great GP service and I would not got through things with out them. But by definition they are general practitioner's and not cancer specialists and most of the time would have to refer me back to the oncology department. Which was a shocking state of affairs. and yes we will all be paying for our healthcare in years to come not something I welcome judging by the stories I have read from H&N cancer sufferers in the states on a FB group I belong to, very scary.
Luckily, that's about to change. The current generation of consultants are not enjoying the ludicrous "pay awards" that the older generation still does. Unfortunately many clinicians claim to have have "special interests", but that does not make them experts... I'm not sure what a consultant could offer you in any case; I suspect that a good Speech and Language Therapist and Macmillan Dietician will give you more bang for your buck. Research shows that clinicians engage in two main coping strategies: active problem solving, and avoidance. Basically whatever the problem, they either try to fix it (possibly with a solution that's worse than the problem), or when they can't fix it, they avoid it (usually by turning to a oh, look, there's a problem over there and trying to fix that). Now head and neck cancer is probably one of the worst cancers there is, and its treatment is absolutely horrendous. Clinicians find it difficult to cope with that, so they seek refuge in the notion that they "fixed the problem" when they ablated the soft mucosal tissues from your mouth and throat with high-energy radiation in an attempt to kill the cancer cells, and studiously avoid dealing with the absolute ****-storm of suffering it caused. It's a bit like Blair and Bush solving the problem of Iraq. My rule of thumb is: if you feel OK after a day's work, you've not done your job right. You're supposed to empathise with your patients, and that means feeling some of the pain and suffering that they feel. This is uncomfortable and draining, so you need to look after yourself and you need to be looked after by your workplace. But that doesn't happen... ...Indeed. Those who survive this neglectful and abusive process are at risk of becoming neglectful and abusive themselves. There are many initiatives to try and reverse that trend (e.g. the Point of Care Foundation), and some Trusts actually take this on board and my colleagues and I can work with them. Many others have just become entrenched, thick-skinned defensive organisms trying to survive in a hostile environment. Staff adopt the Trust culture. And then, like abused children becoming abusers, they pass it on to the next generation of trainees.
Just had a look at this particular consultants profile page again and listed under 'Special clinical interests' is Disorders of voice and swallowing/Laryngology Head and neck surgery (benign and malignant) Thyroid disease Salivary gland disorders Which pretty much covers all the issues I had/have but he was not interested even when I started bleeding from the throat and he was asked by other consultants to have a look at it, I got the impression he would have rather have been somewhere else. As for Speech therapists and dieticians both these people need to understand the cause of the swallow difficulty before they can offer advice. I still see a dietician on a regular basis but it took a 7 hour round trip to Leeds cancer hospital and have a video-fluoroscopy there to get a complete diagnosis of my problem. I had had, or thought I had had two previous video-fluoroscopies in Edinburgh but on both occasions the machine could only take still. Something that I did not find out until A I had asked for a copy of my medical records and then having to go to the information commissioner to actually get the video files as the hospital had used everything from the Data Protection act to I would not be able to convert the file format to something I could view. The were in effect trying to hide the fact that I had not had a true video-fluoroscopy on either occasion. It got to a stage where instead of trying to recover from the most debilitating condition I had ever experienced in my 60 years of life I was battling a bureaucracy that was hell bent of making my life worse. The dirty tricks they pulled or tried to pull were quite something and all aimed at getting the complainer to give up which I almost did on a few occasions. But They did beat me in the end I just could not afford to continue the fight. Anyway thanks for the chat, it has been good to get some of this off my chest.
How you were treated (clinically and as a patient) sounds outrageously bad. I wish I could say I was shocked and surprised, but I know these things happen all too often. For what it's worth you may want to share your experiences with the Point of Care foundation. They have a reasonable amount of political cloud, especially in the wake of the South Staffs. NHS scandal, and I think they may be interested to hear about your experiences.
