[graypegg]

To some extent, there is actually an incentive to have low-value paperwork in a health system. There's only so many resources, and adding friction to the process is a form of "how serious is your issue, really?" triage. It obviously falls apart where the doctor is doing the same thing they normally would, just now with more paperwork, but it may make them think twice about doing two blood tests when they have a hunch the first one is the most relevant.

Of course, that sucks for every metric of a health system that actually matters (outcomes), but this report could reflect one hand of the government not talking to the other.

[DrScientist]

You seem to be under the assumption that Doctors aren't interested in triaging, and the optimal allocation of resources. Of course they are - they want to be spending their time the most effectively in helping patients.

They don't need a paperwork hurdle to decide whether a blood test is needed.

Another reform that causes endless problems is the idea of patient choice/patient voice - which means vocal patients who are good at playing the system, and who are prepared to complain, suck up a disproportionate amounts of the budget - as it's easier to spend unnecessary time than it is dealing with the complaint paperwork.

Note the common theme of the above two pathologies - a systemic lack of trust in professionals ( in this case doctors ) in being able to do a good job - by people who aren't said professionals....

[graypegg]

No I do agree with that! I assume doctors are working in the best interest of their patients. That includes not running arbitrary tests. But I can also imagine a bureaucrat thinking an explanation for each test to be promoting "transparency". (Read: discourage spending as transparency in this case means you're being audited, reflecting that distrust of professionals from non-professionals.)

Not saying it's a good thing! Just that one team has been told the forms are important by another team, so they pitch automating the filling of the form, rather than the obvious solution of: no form.

The patient choice aspect is interesting. These processes becoming a game played by people wanting to take advantage of the system is another aspect where this form-heavy process fails, but a bureaucrat could argue that it still (however badly) discourages overconsumption of the system from patients.

Edit, I should mention: I am Canadian, though we have similar issues with our provincial health systems. If there is a specific British/NHS aspect to this I am missing, that will be why.

[DrScientist]

I am talking about the NHS - but challenges around balancing trust v. bureaucracy is universal - public/private, large and small.

The problem of politicians without a small amount of knowledge enough to be dangerous being led astray by consultants with whiteboard/napkin level simplistic visions I suspect also crosses national boundaries.