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Funding of the public sector is vital albeit intangible

I have read the recent superb article on public hospital funding by Chris Johnson with great interest (Australian Medicine March 19, 2018 Business as usual not good enough for public hospital funding).

As a Consultant Radiologist, I work full-time in a public tertiary centre after having worked for 20 years in another system entirely public funded. I was a Consultant in the UK before working in Australia. I love my career in medicine.

Your sentiment (that of AMA President Dr Michael Gannon, who is quoted in the article) is strongly felt. The UK will suffer for outcomes and investments but couldn’t stretch the public dollar any further. There has been much brow-beating. We have produced quality research and are ever resourceful around cost savings.

The continued funding of the public sector is vital but intangible. It is grossly under-valued. The smaller units operate in isolation and ‘re-invent the wheel’ without much sharing of good practice. Tertiary centres rarely instruct.

In my personal experience, the public sector does most of the time-consumptive training of medical students and registrars – tomorrow’s doctors. The public sector deals with the most difficult and severe cases that the private sector has no interest in and positively ignores. The most needy don’t seem to have private health cover.

Friday afternoon – bank holidays. The public system is ‘open all hours’ at whatever cost. The private sector will judge profitability around out-of-hours work. The private sector doesn’t appear keen on running Consultant-heavy multi-disciplinary meetings that are unfunded for those involved but in reality save thousands of dollars around unnecessary patient care, unnecessary operations, needless investigations and potential complications. The medical literature and evidence base is deficient here for sensible guidance. There is no financial incentive. 

However, if as a patient, you attend a private provider as opposed to a public environment, you will be more likely to see a Consultant ‘at the front door’ who might avoid a hospital admission through clinical experience and expertise. 

Undoubtedly, some clinical scenarios –  myocardial infarction, trauma and stroke – will need urgent unpredictable input while the private sector books out-patient care and over-investigates the fringes of medical need. Some conditions can benefit from a period of observation before a myriad of expensive tests are booked in parallel. There is little priority of investigations. It’s everything now! Paradoxically, volumes of needless work will generate significant incomes in many environments.

Publicly, more junior individuals will assess the most needy, admit to beds and order downstream costly investigations while they await any senior input. With so many providers, joined-up patient care is a diminishing reality. Conflicting interests abound. Some services are duplicated locally in a costly fashion without any scrutiny or accountability. What is a tertiary centre but a ‘dumping ground’ for cases the private sector can’t deal with? 

To many, the current system could be perceived as doctor-centred service without a patient-facing, single funded stream-lined approach. If the efficiency of the NHS had decent financial investment it would be unbeatable. Obvious gains are evident without a quick fix. Juniors have known it no other way and more and more accept the inequalities.

Who can intervene with a feeling of disorientation in such a complex setting?

Name withheld by request