Friday, July 14, 2006

Schildbuerger Streich

The Germans have a series of allegorical tales in which the citizens of Schilda (the SchildBuerger) embark on a range of schemes that seem, at first sight, logical but on closer inspection turn out to be totally misguided and pointless.

A famous story runs like this – the Schildbuerger have no salt and so must buy it from the nearest big city. This is expensive and the people of Schilda are not rich. They call a town meeting and decide that something must be done. ‘Surely’ says one man “ if we grew our own salt plants there would be an endless supply for us”. The others agreed that this was a great idea. They set about collecting money from all the people to buy two large sacks of salt from the merchants in the big city.
The salt duly arrived and one of the local farmers volunteered his best acreage as a salt field, greedily hoping that he would get a bigger share in return. The salt was ploughed into the soil and the Schilda congratulated themselves on their superb cleverness.
In autumn they returned to harvest their salt plants, but found only a field of nettles. The farmer could never get crops to grow in this field till the end of his days.

Now this is a fun kids story, right? Except today our politicians have set out on a great ‘Schildbuerger Streich” New Labour decided that doctors were barriers to reform in the NHS. They have been suspicious of doctors ever since Bevan’s famous pronouncements about stuffing mouths with gold. It was determined that doctors were running a closed shop, artificially restricting the practice of medicine to registered medical practioners. This clearly wouldn’t do as the Government is interested in ‘delivery’ by which they mean targets. These targets are not to do with improving the quality of health care, simply increasing throughput.

The mendacious doctors were resriticting the numbers of qualified consultants and general practioners (GP), probably to ensure the private practice market wasn’t flooded and fees remained high –or at least this was government thinking. The key to this was the Royal Colleges These institutions set the training standards for those who wished to become consultants and GPs, prescribing length of training, setting examinations and monitoring the quality of training. Despite having done this for hundreds of years in some cases, they were not felt to be ‘fit for purpose’.

They had to be replaced with a body that would not stand in the way of progress. So in place of the colleges was erected the ‘Post Graduate Medical Education and Training Board”, rapidly abbreviated to PMETB. This body would ensure that training was ‘fit for purpose’ (i.e. rushed to boost ‘consultant’ numbers) and that there were no ‘undue barriers to progress’ (i.e. make the exams dead easy so everyone passes first time). However despite much fan-fare, appointments of ‘lay people’ and the ensconcing in plush offices, no one had bothered to find out how to run post-graduate medical training. Suddenly they realised that a staff of twenty people with no experience could not do the job. But luckily they knew just the folk to help them out, those pesky barriers to reform, the Royal Colleges. So now the colleges set curriculum standards, prescribe length of training, set examinations and monitor the quality of training, PMETB acts as an expensive rubber stamp and everything goes back to the way it was. Truly a Schildbuerger Streich.


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