Panorama 18/08/08

Panorama today is about The so-called Post Code Lottery. And, by proxy, the good old NHS. Obviously, in this case, it is anti-NHS.

I've said it before and will say it again. I don't like bureaucracy. I hate it with a passion, in fact. Especially within healthcare. But, I don't necessarily agree with the programme. Whereas I think it's harsh that someone in one area of a city can get a certain treatment whilst another person elsewhere can not, this is not a black and white situation. It's local decision making at work.

Now, despite the fact that Panorama has been dumbed down a bit, it's still a good investigative journal. But today, I can't help but feel it's being rather tabloid. It takes headlines and blows them up. It takes young people with their lives ahead of them and turns on the waterworks and violins. It picks TV-OK examples and tries to warm - or chill, in this respect - the cockles of the heart. It's a bit of a cheap shot at a complicated issue.

NICE exists and is a necessary evil. And, although the people who work for NICE are not fully paid, you couldn't pay me to do their job. As any textbook will tell you, the NHS is a funny old game. Finite pot of money VS. masses and masses of problems. NICE try to make that work, somehow. But obviously, it filters down the system. And there are traps, sieves and gutters until it gets down to the people who matter: the patients. These traps, sieves and gutters actually count as the much trumpeted local-decision-making.

See, back in the day there was once a land of central decision making. And then people wanted to dissolve power to local authorities. And the-powers-that-be did so. And then, this happens.

I don't know what the perfect outcome is. Some people will complain if you give too much power to consultants, like Panorama suggested should happen. Some people will complain if you give too much money to mandarins. Some if you give it to politicians. The bottom line of this day and age seems to be: Your life is worth about £30,000 a year. And that's just economics. Medicine is economics, like it or not, and the NHS will never suit everyone.