I am really enjoying my job as clinical director since July 2007. It has been a good learning experience, however, I have to say that viewing the NHS from a management perspective has done nothing to decrease my skepticism about practices in the NHS and the virtually complete dissociation of most consultant staff from flow, acute activity and the consequences underperformance in acute areas of the hospital.

I hope to be able to put forward my personal view in a series of posts on the blog. I would like to point out that these views expressed in this blog and especially in these series of posts are entirely my personal views and do not represent those of my employer, the NHS or the Department of Health.

With rationing in the NHS being an unmentionable phrase that we all live with, maybe it is time to approach the allocation of resources in a more rational way.

An interesting write up in Harvard Magazine (From Anecdote to Equation) looks at the approach proposed by Ramsey professor of political economy Richard Zeckhauser and coauthor Peter Schuck in their book Targeting in Social Programs: Avoiding Bad Bets, Bad Apples, and Bad Policies.

In any system (such as the NHS), unless resources are unlimited, there will always be some form of "rationing" or rationalizing of treatment choices & delivery. If decisions are made on the basis of a formula that ensures that the "best bet" gets the resource it needs, although cruel in the short term, will result in a fairer system and a healthier population.

Watched Sicko last week. A grave indictment of the healthcare system in the United States. I am sure that there was poetic license in depicting certain issues, however, it did make me feel fortunate that I live in the United Kingdom and don't need to worry about being left without healthcare. The NHS was depicted very well in the movie and Michael Moore was very surprised and amazed that all treatment is free for everyone in the NHS. I work in the NHS and believe in it.

The NHS is not without its faults and problems, however, knowing that if anyone becomes ill, whatever their social or economical status they will be treated well and never have to worry about how much it costs. Of course, all of us taxpayers are paying for the NHS in the form of National Insurance and I am glad that we haven't descended to the depths of thinking why the employed should be paying for the healthcare of people that are not taxpayers.

Privatisation is creeping in gradually into the NHS with outsourcing of elective surgical procedures and managed healthcare being held up as the mantra  for solving the NHS problems. Let us not forget what a great system the NHS is and at the heart of it lies the fact that everyone deserves healthcare whether they can afford to pay for it or not.

I think that the movie should be mandatory viewing for every politician, healthcare "meddler", doctors and NHS managers - especially those who cannot stop from whining and criticising the NHS.