Dear Santa,

28 11 2008

Yesterday I was involved in a fairly high level planning meeting to rationalise and develop the trauma service provision for a region. There were many important and knowledgeable people who planned and discussed and theorised and developed what could be an exceptionally good service. Then someone asked the key question, “Will the Primary Care Trust support this?” There was a sad shaking of heads. And then I realised this was probably going to be happening all over the world for the next month.

Please Santa?

Every year at this time children excitedly “write” their lists to Santa. The whole intricacy of what goes on is hugely complex with parents listening for ideas and themes but also bringing  a gentle sense of realism so that come the fantastic day they can meet some of the little darling’s expectations but also within their own financial limitations.

The sadness is that is exactly how we see medical management often works; the clinicians actually often come up with really impressive ideas about developing a service local or even nationally but the financial limitations of NHS prevent this coming to fruition. Even worse the inability to plan long term brings frequently brings about short term solutions that neither meet the demand nor save money in the long term. In short rather than getting what we would like to provide for the health of the nation on Christmas Day the package under the tree only holds disappointment. The contrast between this and the American Hospital buying a da Vinci robot to essentially keep up with the Dr Joneses is stark.

And yet again we have a problem of clinicians and management of the health service where the aspirations simply cannot be met. Whilst clearly there needs to be some reigning in of unreasonable demands at this time of year there is a huge difference between shopping at Poundstretcher and slightly more upmarket boutiques.

The heartbraking part of it is that trauma is the leading cause of death in children and young people and there is clear evidence that improvements in trauma care delivery bring about improvements in survival.

Do you think Santa has anything in his sack this year for trauma provision?

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