What can you tell us Yanks about Healthcare in the UK

Thought I'd throw some additional links into the mix:

The NHS is the world's third largest employer.

A quick browse of the NHS Information Centre shows us that since that 2004 Times article, the NHS workforce has grown to match the combined populations of Liverpool, Manchester, Edinburgh and... Hereford.

The simple, simple reason for the lack of a 'central pot', is the sheer logistical impracticality of it.

You'd have to issue compulsory purchase orders for the whole of Manchester to fit all the NHS Administrators in one place. And if they needn't be in one place, then you'd have local departments. And if you have local departments, they might as well have local budgets, because it makes more sense if the Manchester office deals with Manchester drug requests as opposed to requests made in London.

Because if something goes wrong, and someone makes a complaint, holding a department in Manchester to account because of a mistake made somewhere along the line between the GP in Brighton, and the budgeting department in Manchester is going to be... difficult. A Bureaucratic Nightmare.

I don't see why you can't go to the doctor; the treatment that you need is provided, and the bill goes straight to the central pot. All a GP will do is diagnose conditions and refer or prescribe treatment.

It is a great idea. What it fails to factor in is the following:

• The cost of paying someone to be in at 7.30am to unlock the doors, switch off the alarms, switch on the lights, boot up the reception computers, turn on the message board and touch-screen check in machine, open the blinds, and let the patients in.

• The cost of paying the two other receptionists who turn up at 8.15am and log in to their computers, amd check in the patients as they arrive, or convey the message to Dr A that his 9:10am is running 10 minutes late.

• The cost of running the computer whilst writing that message, and the cost of the lights being on so the keyboard can be seen properly to do this.

• The cost of the locum doctor coming in for the morning clinic because one of the normal doctors is on holiday with the kids, and the cost of running her computer and lights all day.

• The cost of the surgical gloves she puts on before she touches the patient, and the single-shot tweezers she uses to remove a stitch, both of which she throws in the clinical waste bins immediately after the consultation finishes.

• The clinical waste bins.

• The people who remove the clinical waste bins for incineration

• The people who incinerate them.

• All of the lights and petrol used in this process.

• The special prescription paper the locum doctor is obliged to print the script on, and the ink used to print it. The USB cable that connects the printer to the computer that had to be replaced yesterday because it was faulty.

• The medical secretary who types the referral that the doctor dictates on the digital dictation device that I spent a few weeks researching.

• The salary I drew whilst conducting that research.

• The salary I drew whilst networking all the digital dictation devices.

• My salary in general, without which no referral could take place and no printer cable would have been replaced (for at least a few days!).

• The fax machine which we use to fax the referral to the Choose and Book people because it is urgent, or the ink and paper used to print out the transmission verification report.

And so on.

I stop because even I got bored of that... but we haven't got to the cleaners who are obliged to come every evening... the leaflets we are obliged to have on display... or the giant hospital with the same day to day minutiae to which we have just referred the patient.

It just is not as simple as patient comes, is treated, is referred, is prescribed drugs, is better.

You can't have a national, centralised budgeting departments for each of the above mentioned things, because no one would be able to hack a life of auditing clinical waste bin expenses. But when you scale up the number of such occurances throughout a workforce of 1.4million, serving a population of 60million, that is exactly what you'd need.

**Exactly the same thing for prescribed drugs and departments referred to. **Something like 3.5million women in the UK are prescribed the contraceptive pill. That is something like 9,500 requests a day, on average. You'd need a massive, dedicated staff to handle the sheer, unrelenting volume of them. And their entire lives would revolve around auditing contraceptive pill requests...