Who Should We Treat? Law, Patients, and Resources in the NHS

Who Should We Treat? Law, Patients, and Resources in the NHS

Who Should We Treat? Law, Patients, and Resources in the NHS

Who Should We Treat? Law, Patients, and Resources in the NHS

Synopsis

Books about the National Health Service have been written by economists and doctors, but it is difficult to get an overall picture of the legal implications of subject. Who Should We Treat? is written by a lawyer who considers the competing aims of patients, doctors and managers for NHS resources. It is the first book to put scarce resources in the NHS into a legal framework.

Excerpt

Lawyers have long been concerned with the personal rights and duties which exist between doctor and patient. Recent tensions in our system of health care, however, have drawn attention to the impact of the National Health Service on their relationship. In any system of public health care, medical resources--doctors, nurses, ancillary staff, buildings, equipment, and so on--need to be managed. Management should ensure that resources are not allowed to lie idle, or be diverted to pointless use. Its purpose is to make optimum use of staff and facilities for the benefit of patients. Paradoxically, just when new systems of management have been introduced and the influence of managers expanded, the concern for the welfare of patients has become most intense.

Previously, the issue of management caused no particular anxiety. Little difference was perceived between the relationship of individual doctors and their patients, and the NHS as an institution and its patients. It made no difference which way one looked at it because doctors enjoyed the respect of patients and health service managers. Doctors had the lion's share of power within the system and, therefore, it was said, clinical priorities prevailed and patients considered themselves to be in safe hands. This perception may never have been entirely accurate, and it seems unlikely that all patients always received all the treatment they needed, but it offered a degree of reassurance that the service was doing all it could. In the modern system, however, doctors are no longer pre-eminent because aspects of their authority are shared with health service managers and resources are not at their complete disposal. When resources are under strain, a lack of coordination and planning could lead to patients being overlooked, or being offered inadequate care. Thus, managers have been given more authority to organize and promote the service.

At the same time, there has been concern that our original perceptions about the basic objective of the NHS, to promote the clinical well-being of patients, are being threatened. When responsibility for management is shared between doctors and managers the centre of gravity changes. Apart from their patients . . .

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