NHS: Saying NO

The government bureaucracy of UK's National Health Service is known for it enormity, inefficiency and waste. First, there are six "trusts" including the acute trust, the ambulance trust, mental health trust and the primary care trust (PTC). Within the PTC, there are something like 300 different job titles, and "There are now more PCT managers than primary care doctors in many areas."

Next, here is a detailed, 38-page list of what the PCT is NOT prepared to pay for, courtesy of Dr. John Crippen, a family doctor who has worked for over 20 years in the NHS. He writes about "The trials and tribulations, the pleasures and pitfalls of family medicine in the modern British National Health Service" on his blog NHS Blog Doctor.

He says this about the list:

A line has to be drawn and there are many treatments listed that few would say the taxpayer should pay for. Drawing lines is not easy, but it seems to me to be cruel that if we are to fund sex-change operations and pay for removal of a penis, that we will not also fund breast augmentation.

The main thing that strikes me, as so often with this government, is the huge bureaucracy that has developed to police these exceptions. In one of the most telling medical blogs of the year, the Ferret revealed the enormity of a PCT payroll. We can expect the list to lengthen further as yet more commissars, this time tasked with preventing people from accessing health care, are appointed. Saying "no" may be important, but the process of saying "no" is in danger of turning out to be more expensive than the health care it is denying.