It sounds to me Keith, that these problems in the UK Health Sector have much less to do with any structures of management whether State supported or not, but rather that somehow this sector has managed to maintain rather traditional British systems (to use the Sociological terms) of status based privilege. These were rife throughout British society when I last lived there in the 1970's and which (to her credit) Dame Margaret managed to sweep away from many parts of British society.
When I last had any direct observation, all of that was very specific to Merrie Olde and was based on historical factors which completely by-passed most of the rest of the World. The problems with the Canadian Health Care System are certainly not that--we don't have much centralized management; no NHS for example, rather, I think the problems lie deeper in the general malaise of the Canadian economy/dollar which has fallen dramatically against the US$ over the last ten years or so, while so many of our health inputs are either priced in US$ (technology) or have to compete for resources (people) with folks/institutions waving US$ salaries. Mike Gurstein -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Keith Hudson Sent: January 24, 2002 7:13 AM To: S. Lerner Cc: Harry Pollard; [EMAIL PROTECTED] Subject: Re: The Health Care Workplace in Crisis I'm extracting just two sentences from Sally's posting of "The Health Care Workplace in Crisis - What to Do ?": <<<< Recent surveys show health professionals [in Canada] are the least likely of all occupations to describe their work environment as healthy. Their job satisfaction is also below the national average. >>>> and <<<< The Canadian Nurses Association predicts a shortage of 60,000 nurses in Canada by 2011. That's 25% of the current nursing labour force. The College of Family Physicians of Canada sees a shortfall of 6,000 family physicians by the same date. Technologists, therapists, audiologists and speech pathologists will also be in short supply. >>>> Harry commented that the situation seems similar to that of the National Health Service in England. Yes, indeed, very similar. There's been a fascinating development over here since my last posting! Since last week, when we starting exporting patients for operations that the NHS can't do for years, English people have been discovering from TV just how superb the private hospitals are in France and Germany. At the same time, French doctors have been discovering from their TV just how much salary English NHS doctors have been receiving. The average family doctor has an income of �71,000 p.a. (US$ 100,000 p.a.). The average French state doctor has an income less than half of that. So they're going on strike! In England, it's obviously not been low rates of pay (for doctors) that's the problem. (Hospital surgeons get even more -- altogether, with large additional "merit payments", making upwards of US$ 500,000 p.a. in many, if not most, cases.) It's the way they have been treated by the top-down highly-centralised system managed by the non-medical mandarins of the Ministry of Health ever since 1947. This is why the whole system is demoralised, dirty, and in disarray. This is why a quarter of trainee-doctors drop out before they have finished (very expensive) training, and why a further quarter drop out within two years of qualifying after sampling life in hospitals and general practice. This is why almost half the nurses in the NHS are now recruited from Asian countries like the Philippines. In a matter as important as health, I really don't care in practice whether a public health service is "owned" by private interests, or the State. (In France and Germany it's a dual system.) That's not the important point. The important one is that all junior staff (including doctors below consultancy level) and patients are treated as unimportant and have almost no say in choice of treatment, conditions and management. That's why a revolution is now taking place in our NHS -- although, as is the case with all revolutions, no-one knows yet how it's going to turn out. Keith Hudson __________________________________________________________ �Writers used to write because they had something to say; now they write in order to discover if they have something to say.� John D. Barrow _________________________________________________ Keith Hudson, Bath, England; e-mail: [EMAIL PROTECTED] _________________________________________________
