Recently I've been struck by the fact that the NHS seems to be going through a phase of Taylorism or (so called) Scientific Management which was a fad in manufacturing management circles in the 1920s, but now seems to be being applied to services industries, as well. The days of the men in white coats and stopwatches not stethoscopes are here.
The idea is that you break down all the actions needed into lots of component parts and look for the most cost effective (ie quick, cheap, and deskilled) option for each. You can see why accountants might like it.
It was a pretty awful (and unsuccessful) management fad, turning people into robots on the factory assembly line making cars, and didn't last long. But it's even more horrifying now, applied to medical services as it makes access to fully skilled medical professionals more and more difficult. You only have to read a bit of Random Acts of Reality, the blog of a London Ambulance driver, to see how it is being applied to save money. And Confessions of a Psychotherapist also has detected it:
The government has responded to the Layard report, calling for 10,000 more NHS therapists, with a consultation paper outlining their proposals for National Occupational Standards for psychological therapies. This paper has a very significant bias towards CBT practitioners and Humanistic principles are largely ignored. Apparently the evidence base is that CBT (Cognitive Behavioural Therapy) is the most cost-effective therapy. I say apparently because: there is very little research into the long-term benefits of other approaches; there have been no longitudinal studies into the efficacy of CBT; all meta-analyses show that the therapeutic relationship is the most significant factor in recovery, not modality, and CBT pays scant attention to the therapeutic relationship.
Next post: how the government intends to improve the well-being of the nation through 10 week training courses for CBT practitioners....keep reading..
This rant was brought on my going to my doctor's new surgery and finding that instead of seeing the nurse, as usual for my blood test, I was treated by a so-called Health Care Assistant, who went through her only routine just like a robot. I imagine she was taught a script pretty much like the people who work in call centres are (who are monitored to make sure they don't diverge from their script). I don't mind seeing a nurse for a blood test, because a nurse is not a robot and can have a dialogue with you about anything you need to know. Everyone knows that people go to see the doctor on one pretext while something else is worrying them, or that what is wrong turns out to be something completely different from what you thought. By making sure that you are seen by a Health Care Assistant robot, the "managers" make sure that you get the minimum treatment in the time, so saving money and "processing more output".
Clearly the idea of holistic medicine doesn't stand a chance.
