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Any organisation, regardless of size, needs to be managed, if it is to be successful and to use its resources appropriately and effectively. To blame management, or to advocate no management, is ludicrous. What is needed is better direction at the very top, better management at all levels, better management information systems that operate in real time, and a good working relationship between clinicians, other healthcare professionals and managers.

If anyone is looking for a quick hit, then I would suggest the abolition of the whole clinical coding empire. Clinicians and healthcare professionals should be provided with a simple, easy, effective and quick means of self encoding, most likely via electronic systems.

By the way, it’s all very well to talk about putting the patient in control by allowing them to pay (possibly via insurance systems), but that approach works only for those who have the wherewithal to act as intelligent (if not expert) customers. Having just gone through the annual ritual of renewing my motor insurance policy, and my Mother’s house & contents policy, I have grave doubts whether I have intelligent customer competency in those areas, let alone in that of health insurance. What of all the deprived and dispossessed in our society? What is to happen to them in such a model of healthcare? A quick look at the USA gives an answer!