Job security and a good episode of Scrubs

Abstract

Is the health service immune to an economic recession? I hold my hand up and admit that if it is a myth I have perpetrated it in these pages. I guess Nigel Edwards, director of policy for the NHS Confederation, would disagree (JRSM 2009;102:86–7 ). Mr Edwards has the advantage of being much closer to the NHS and its finances than most of us would wish to be. Moreover, he has the unenviable day job of bringing the hyperbole of politicians down to earth. Primary care trusts and healthcare providers will feel the chill of disinvestment, suggests Edwards in his matter‐of‐fact editorial. He is concerned that quality of care will suffer. These are uncomfortable conclusions that call for our health service to implement greater efficiencies, something that many health professionals will find impossible to imagine. Nonetheless, is it difficult to believe that the financial crisis will affect healthcare in the way that it is devastating other industries and sectors? A hybrid operating theatre might be an efficiency that is worth exploring (JRSM 2009;102:92–7 ). Mark Field and colleagues describe their experience of a purpose‐built hybrid theatre constructed at Liverpool Heart and Chest Hospital as part of the development of a regional thoracic aortic aneurysm service. Their conclusion after a single year’s experience is that improved collaboration between healthcare professionals is an important benefit for patients, and represents a new standard of care. A drive for efficiency is a spur to innovation. All organizations are seeking to innovate, with the magic formula introducing cost savings while exceeding performance targets. For many, this is an impossible calculus. Cutting costs may well reduce quality and performance, as Edwards warns. Yet the introduction of any new technology, like the hybrid theatre, requires a more formal economic analysis so that the technology is introduced for better patient care rather than for the sake of its application. Our revolutionary new technologies might be considered to be failed old ones by future doctors. Richard Smith was asked to give evidence to the Royal College of Physicians working party on the future doctor (JRSM 2009;102:89–91 ). Among an exhaustive list of thoughts about our future colleagues, he includes an important requirement that doctors have an understanding of systems: ‘Future doctors need to understand those complex systems and know most importantly how to improve them.’ Nigel Edwards would welcome those skills among current doctors. Future doctors, however, will probably find it hard to understand why those skills are required at all? In the era of the credit crunch, the appeal of medicine is probably job security and a good episode of Scrubs.