Nadeem Moghal
The fragmented NHS
Consultant paediatric nephrologist and Fellow of the NHS Institute for Innovation and Improvement.
Recent activity
Blog Posts (4)
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PbR: A target by any other name...
PbR as an abbreviation now lends itself to a much clearer redefinition for the providers of healthcare services in NHS England – ‘Patients bring Revenue’.
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Have your say on the NHS - 'an election in less than a year'
The BBC news web page has a link to ‘have your say on the NHS’ this week; the NHS is back in the news as a political football.
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Retiring leadership
As a senior clinician approaches retirement, colleagues arrange little or even large gatherings to mark the occasion.
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Competence or expertise – you choose, if you have a choice
Workforce planning is an ambiguous art made yet more ambiguous when set on a national scale with its unconnected, conflicting and changing priorities – still, we try.
Nadeem Moghal contributes to:
Comments (9)
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Comment on: PbR: A target by any other name...
PbR is a rather large elephant and as the fable goes, some see parts of it, but few see it as a whole...PbR has revealed those activities that are profitable, and so as is the nature of the human condition, it is those activities that are being actively sought, but not by medics - who have no immediate financial gain from PbR - but by the organisations that know the value of profitable vs. loss making activities. In PbRS England there is evidence to show that specialities are receiving investments because the activities generated are profitable and for which demand can be directed and manipulated. The damage done to other providers and specialities is real and the impact can be found in more than one report. Read the blog again - It wasn't a medic that called the GP to ask why demand had dropped. Management behaviour as a consequence of the PbR policy - who is regulating that? The US 'seek it, bill it' culture is regulated, despite which the costs have inflated – if the size of your salary depended on how much work you did – might that influence how much you did? PbR is generating activity based targets. Today it is for the apparently non-profit making hospital. Tomorrow it may be for a John Lewis Partner working with a PbRS England partner, where profit is the driver. Step back and look at the Elephant.
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Comment on: John McGowan: the truth about markets
This article so wrong on so many points! Healthcare is not a business. The customer is at a serious disadvanatge on so many fronts when confronted with a need rather than a 'want or desire' for a commodity; there is therefore no real choice. There is a need. Who has the overwelming advantage to meet that need? The provider. Give that provider the added incentive for proft and you will end up with the US model. And before you start pointing twoards Kaiser or ony of the other small models of study - remember why they are models - they act as a commune of services, pay salaries, not profits and some keep away from high risk work. Don't be taken in by the sense that 'business priciples' will solve the problem - Read some Deming and all will be well...
