Debate No.1 (April 2002) - The Budget

[Gurpal 278]

Gordon Brown has raised taxes to boost spending on the National Health Service by £40bn over the next 5 years. The extra cash means the NHS will get 40 new hospitals, 500 new primary care centres as well as 35,000 more nurses and 15,000 more doctors. What do you think about the Budget? How would you spend the money?

[Guest mince]

As I read about it I was happy. More money for the NHS, combined with the recently raised profile of mental health in government 'targets', it certainly protends oportunities for psyches to get more done for our dearly beloved patients.

But naturally I have doubts. they say he's gambling on more growth than any majority of analysts think is likely. Will this also see our relatively quiet and laid back water invaded by increasingly political directives. Propted by media led 'outcries' no doubt.

Then there is the question of 'is this enough?' or worse, is the money there to buff up th NHS for a turf off to the private sector. After all it is commonly believed that this is where the trend is heading for the NHS.

Man I am a cynic. But I supose that implies some sort of core idealism.

How would I dispose of the readies?

(my manifesto)

The NHS has to grow up and join the rest of the commercial world. people come to the UK to see the queen, some of them come to get health care. why is there such a waste of time wondering if a pharm paper is just marketing rather than science? the NHS could own such companies, they could be run with less commercial bias.

(there are no doubt international laws governing how involved in business States can become. I am sure the vast majority of states adhere to them. strictly.)

So how to spend the money?... for psychiatry ofcourse

1. I would create more theraputic communities.

2. Go big time after the 'drug problem'. (this one is a very slippery customer, it is about just how must responsibility States will alow thier charges to have over their lives, so psyches will have to wait and see how the wind blows like everyone else).

That's it for now.

What do you guys think?

[Guest satya]

;)I agree with mince, pharm companies should be owned by nhs after all ,most of the work is done by nhs doctors,mind you the eli lily daily research budget is a million ,i am led to believe. 8)increased money is good,but middle management should be cut out,professors banned ,clinicians who work be paid more including all the other nhs slaves.

???the london marathon has collected 150 million to pay for medical charities,mainly cancer or cardiac based ,this should be funded by govt and money collected by sport should go to budding athletes the swedes pay 60% tax and their medical system is better :'(

[Guest satya]

8)the other suggestion is for doctors to practise less defensive medicine, give a honest standardised care,but when events go wrong instead of spending years paying lawyers to defend us a no fault compensatory system pays damages,this will prevent unnecessary investigations and admissions :-X

[Guest justin]

I find your point about banning professors most curious.

Since clinical professors do clinical work and also research I presume you are objecting to NHS money going to those conducting research.

May I remind you that psychiatry is a branch of medicine, which is a branch of science. Therefore as a practising psychiatrist your primary doctrine should be science and not religion/pseudoscience/personal philosophy.

If your point is that most research takes time to have a clinical effect then this is not only false but even if true would show a shortsightedness which belongs in the realms of frontal lobe abnormalities.May I also remind you that without the body of research that has been accumulated in psychiatry you would still be treating your patients with leeches and warm baths

[Guest satya]

leeches and warm baths will certainly do a better job than some of the treatment we dish out,my point about proffesors is that they create a culture /subculture of so called academics,where as research can be done by anyone, a profesorship gets you money and name on everything and reason to skive,get them to see apatient and you will know

why

[Guest justin]

It is up to the individual to live up to the role that is given to them.

Some of the money could be given to rewarding those clinicians that do research on top of their clinical workload, or else lecturing etc.

[Guest satya]

:oprimary care increase is a great thing ,but money always goes to cardiology and oncology.we need to raise our profile. 8)

[Guest Olivia_Will]

I have to agree with Justin here. 'Primary Care' implies a patient-orientated approach to provide appropriate care. Why should a grassroots approach be incompatible with research? Without academia, providing the thrust onwards and upwards, primary care would stagnate. Outdated treatments, unchallenged doctors and uninspired patients would result.

If we can break free of the mindset of 'plugging holes' and use the New Budget resources in novel ways, the NHS will really be reformed. Thankfully we have academics, trained to use their minds creatively, with experience in turning ideas into results! I'm hopeful we'll see regeneration of all us doctors - an opportunity for *all* of us to think and experiment with our new resources - in the true medical, scientific spirit - to benefit our patients.

[Guest satya]

::)justin and polly are missing my point, academics are inspiring,but 'absolute power corrupts absolutely'.Some do work hard,but in this country they seem to reinvent the wheel a lot, it is difficult for ordinary folk to get money for research without tagging on a academics name to the project and often they have their nose buried in the sand,so despite thousands of pt:clinician interactions simple questions are not answered,eg what is depression?

:'(we are also bad at saying we cannot help,falsely raising people expectations of ourselves,hence unnecessary investigations and treatments.this certainly does not mean i am for managed care, ;)but there has to be limits otherwise the money will disappear into a bottomless pit the debate is about the budget,may i remind everyone :

[Guest justin]

Yes the debate is about the budget so a separate thread might be necessary to tackle the offhand remark about academia

corruption/power blah blah applies equally to clinicians wanting to avoid any research whatsoever - quite common - and they usually get their way.

I suppose we still havent answered the question of what we should do with the money.

More psychiatric nurses is the first point - especially liaison nurses who I think would be particularly useful.I think sheltered employment schemes would be particularly useful - getting patients back to work as part of a rehabilitation process - as quickly as possible

More CBT/CAT/whatever practitioners e.g. make up a new role - Psychiatric CBT assistant - could train non-professionals to take up caseloads.

Protocols would be an important part of allocating resources. E.g do some research into whether or not EEG/Chromosomal analysis/MRI should be included in routine workup

[Guest justin]

The smart thing to do would be to spend the money such that its impact is over a longer period of time - probably involves some preventative medicine as well.

Unemployment clinics for example - acute adjustment/chronic adjustment reactions/marital difficulties/self esteem/depression - get OT's/job centres/psychiatrists involved - get them back at work quickly.

Or life events clinics along similar veins since life events correlated with various psychiatric illnesses.

More money invested into child and adolescent - e.g. drug research to stop the problem before it starts in adulthood.I think that training non-professionals in very specific areas is the best because its the cheapest option and gives a huge increase in manpower

[Guest marianna]

I think we need to spend some of the cash on research to evaluate all health professionals work environments- shift systems, supervision, workload, case mix and also pay to an extent. We need to make the jobs within the NHS sustainable up to the age of 65 or whenever retirement could be to prevent the massive problem of burnout, loss of staff to other fields, lack of CPD and job satisfaction.

Who doesn't know an acute unit where at least 50% of the staff are not totally fed up or actively seeking alternative employment?

[Guest satya]

shut shop at 6pm i say 8)

[Guest mince]

It is important I suppose to stick to the debate point. (But no bolts of lightning have shot yet from almighty webmasters restless fingers so..)

Justin reminds us...

'psychiatry is a branch of medicine, which is a branch of science. Therefore as a practicing psychiatrist your primary doctrine should be science and not religeon/pseudoscience/personal philosophy.'

Perhaps these issues are another debate altogether. I will put in my pennys worth on this one though.

Psychiatry is to medicine what a baby is to a full grown adult. Psychiatric papers much more than medical are open to a wider range of critical attacks, even at fundemental philosophical levels.

So pschiatry is in my opinion not a science and yet to determine what it is.

This I supose is why Psychiatric academics need to be more eclectic and vissionary than their more hard science based coleagues.

Relating this to the question of where the budget money should go...

Before deciding how to spend money on the mental well being of The People perhaps you have to decide whether (Scientific) Psychiatry is the best means.

[Guest justin]

Short aside: All psychiatric papers do not necessarily represent psychiatry - they may give themselves the name but do not uphold the spirit. The more I think about it, the more important I think these questions are. If one does not define the problem/area, then how can one spend the money on this area effectively. Psychiatry is a science and if this is not understood by practitioners then they are wasting money. The process of science is so slow that it usually takes the cumulative effort of many people to make slight progress. But this progress is one of the advantages - provided the method is used. The end result of the scientific method should be better patient care - and I can prove this in a thousand different ways if needs be.

[Guest Fin]

I agree with Justin, quit picking on the poor professors!

Whatever about Sweden, I read that Norway have lower taxes + better health care. But it was in some Sunday paper, not a peer reviewed journal.

I'm not a fan of increasing the amount I pay in tax. Do the maths and about 85% of every pound you earn goes into tax (direct, plus indirect via duties, VAT, every time you buy a service some of the servers income is taxed etc). They penalise those who work, and squander much of what is received.

However given the scenario I would do a bit with the cash -mostly pay awards to aid medical recruitment+equipment aquistion, and a bit of income generation restruturing whats already there.

Recruitment of quality staff who feel well rewarded is key. The long awaited working time directives aren't far away. Kids now get good careers information at an early stage (medicine now has less status, and there is more money, less exams, and less hassle in a variety of other professions). There is going to be a considerable shortage of doctors, particularly in psychiatry which has lost it's early retirement and lighter workload benefits. This is a sensible time to take steps to address this.

Undergraduate training could be shortened, and workload lightened. (Of course that's not to the benefit of those of us already qualified, but anyway). Calmans crazy training system could also be addressed, shortened and made more clinical and less academic, with more emphasis on optional short focused + assessed courses if you want to enhance your C.V., than membership style monster exams. Otherwise how do you expect to get a 'consultant led service'.The N.H.S. can then pay a few boffins to produce and update clear treatment guidelines.

Large rises in consultants+trainees base pay (to at least twice dental salaries at every stage of employment, if you want to maintain medical recruitment). -If you want quality docs+hard work, you have to pay for it.

The option for all trusts to exceed these 'minimum pay' awards to promote competition for good staff (+hence promote staff to be 'good').

24 hour use of all high cost fixed assetts (operating theatres, scanning equipment etc), to get the best value out of the aquisition costs.

16 hour use of medium cost assetts (outpatients, offices etc.)

Allowing income generating options, e.g. options to 'purchase' various extras -private rooms, higher quality meals, evening appointments, 'weekend' day surgery, copies of investigation results, non-generic drugs, additional (non-neccesary) investigations etc. + encouraging private practice to run in parallell the N.H.S.

As transport options and links are improving the more costly 'community' hospitals are becoming less neccesary and a degree of centralisation is a better use of resources.

Divert monies being wasted elsewhere (prisons that are not generating an income, those getting income support not having to work for it, excessive court awards from the public purse etc etc.)

The usual stuff.

For psychiatry; larger in-patient units with secure gardens and surroundings to allow ill patients more freedom of movement, and 16 hour day hospitals with O.T. etc, development of 'atypical' depots, + depot mood stabilizers. Urgent admissions being a minimum of three days (to reduce revolving door admissions for minor crises etc). Would all be a great way to spend some of that cash.

Oh yes, and better computer facilities and a nicer on-call bed at my hospital!

[Guest satya]

Justin is right, science is about serial observations......

not all policies are based on gold standard evidence , ::)ie...RCT but case studies example Christopher clunis enquiry.

8)we have to give up this notion of being good and working hard working efficiently yes.

why lock people up when they can medicate at home

they are the ones with the problem,let them decide how best they should be tested if they have capacity