Friday, August 15, 2014

Eeny Meeny Miny Mo

I loved him in Good morning Vietnam...there was always something about the clown with a tinge of sadness in him..and it wasn't just comedy. If you wanted to know about his acting chops...watch one of the classic Chris Nolan movie..Insomnia..head to head with Al Pacino and Hillary Swank..simply an artist. So had to wince a bit when the news flashed about Robin Williams..another celebrity taken away due to mental health issues...and the issue got the focus it has always deserved, some good and measured; some downright awful and morbid..but it got the attention. More closer to home, Shaun Lintern who is not afraid of rocking the boat (Shaun, that Superman logo isn't you...try a Bat symbol...much more of a rabble rouser) published his investigative findings on mental health issue and it's provisions...and makes for grim reading.If you haven't read it, suggest you do..crisis? Nope it's close to apocalypse now. As a physician, I know so from ward rounds..Shaun's work just confirmed it.

The million dollar question however is what now? As I mentioned to a few colleagues, pick ANY service and you will see holes, some more than other, but holes none the less. And to every single person I have asked one question..but the answers have been ethereal, abstract, wrapped in buzz words, catch phrases...none, I repeat, none of which actually solves the problem.
So here is the question...we know mental health needs funding...in our cash strapped environ...where will you get it from? In the spirit of multiple choice questions, try this...

Option A: Raise taxes (Pros: will throw more money at system, according to some ONLY way out; Cons: Look at the wastage within the NHS ?..sure more money will solve it?)

Option B: Abolish competition, make it a monopoly (Pros: transaction cost saved,procurement issues lessened etc etc; Cons: lack of it may raise issues regards where the drive exists to improve..any attempts based on data is anyway neutralised by most poo-pooing them on basis that its either a cock up or a conspiracy)

Option C:  Prioritise services; accept that to provide high quality services, you may need to prioritise some above others (Pros: Gives opportunity to develop those services properly, not pay lip service Cons: who chooses the second tier services and based on what?)

Option D:  Do nothing and stick to camps based on ideology and have a shouting match.

Option A may happen..but where do you stop? Keep on raising it with demand and need growing exponentially? Option B: Perhaps gives you a release as a one off saving ..still not convinced how that drives quality..but then what? We do the cycle again?
I put in Option C simply because we already have that steadily, if not by stealth. Lots of areas have procedures not funded by the NHS or needing permission."Free at the point of delivery"? Or "Free at the point of delivery chosen?"

Here's a question...what's more important ..mental health services or diabetes?Cancer treatment or well funded primary care? Midwives or treatment of Psoriasis? Tough, isn't it? But the answer is simple...based on who you are asking. If you have debilitating rheumatoid arthritis, for you, that's the service of prime importance...it may not be maternity services.For the mum struggling with a 2 year old who has type 1 diabetes, it will, of course, be a fantastic type 1 paediatric service, it may not be a COPD outreach service or a dementia service. And then there are the charities..quite rightly driven by the prism of their own views.

So we come to an inevitable cross roads..and frankly I do not envy any policy maker, any politician who has to make those calls...it's always easy to criticise than to do...and will forever be. But time may it be too far away before society is called upon to play this game of MCQs..as tough as it will be. What started as a fantastic development of socialised medicine now comes to a crucial juncture.
The fundamental question is..will we make the decision based on sound facts, reason or are we going to be driven by emotions? Are we going to be able to make a tough decision which will not make all happy..or are we going to roll the dice and see what comes up?

Time stands for no one...and this question will keep coming back..again and again. So have a think..when you are asked the question..Choose wisely. Better that than a game of eeny meeny miny mo..right?

Next week: "GPs, vacuous leadership and inevitability of strife"

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