The Witch Doctor envisages young lady doctors being shunted around clinics to provide staff cover and a bit of diagnostic sense. This may keep the “Competent Clinical Decision Makers” of the coming order from making too many mistakes. Undoubtedly this will be a bad idea, but every cloud has a silver lining so perhaps it will make it easier for the doctors to pick up a few groceries at the supermarket while they’re there.
It seems the idea originated in an Iranian nursing study and was latched onto by the Royal College of Physicians (RCP) at a time when government planning had ruined the careers of many junior doctors and created foreseeable shortages.
The LEAN-ness that is doing the rounds in the NHS is not the genuine Toyota City variety. It’s probably the General Electric variety, from America, where Scientific Management began. Toyota sell cars and sewing machines. They never said their methods worked for hospitals. The consultancies have repackaged Toyota ideas into a new product they can profit from. Like inspection bodies, management consultancies sell whatever theories they can and walk away leaving the responsibility with someone else.
John Seddon has written here how the principles now taught as lean are often contrary to those practiced by Taiichi Ohno at Toyota. Improved quality and lower costs follow from dealing effectively with variations in consumers’ demands. They don’t come from standardisation and cost-cutting. NHS procurement of flimsy envelopes with non-stick glue cuts costs only at procurement. Everywhere else in the hospital it raised costs. The failure demand from incompetent Competent Clinical Decision Makers will exceed the current cost of the same quality.
Accreditation is essential to be able to say that Any Qualified Provider (AQP) has quality. Assessment by UKAS is to the RCP’s own standard; perhaps this will make more sense than ISO 17025, or perhaps it will have been too influenced by it. If the RCP standard is better than ISO 17025, why does ISO 17025 remain so onerous? If the RCP standard is more lax, are they bothering only in order to enable Any Qualified Provider to bid? Will there be any evidence of the standard’s effect on patient outcome, or will it be snake oil like laboratory accreditation?
The move is another sign of professional organisations working with government for the dissolution of vaguely efficient medical services under the guise of quality. Expertise, integration and genuine quality will be replaced by training records, accreditation and compliance audits. And a certificate.
We see from this article that UKAS’s CPA lies down before the government’s management plans. It won’t lose its monopoly market by rocking the boat. CPA is not the guardian of quality it is sold as.
Likewise the Royal College of Pathologists is suffering resignations as it also finds itself powerless in the face of government plans.
We’re still waiting for a report entitled Destroying Working Lives.
When the true quality is gone will AQP really be cheaper?