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Monday, 20 November 2017

The Dead Horse Theory. "When you discover that you are riding a dead horse, the best strategy is to dismount!"

The Dekota Indians had an excellent theory, and it is one that the many governments around the world which are struggling to fund their national health service, dominated by pharmaceutical drugs and vaccines, might benefit from learning. It is the 'Dead Horse'. The 14 points that follow clearly represents the current strategy many governments use, including the British government's policy towards the National Health Service.

The NHS is in constant crisis. It spends an enormous amount of money, mainly on pharmaceutical drugs and vaccines (= the dead horse), yet year by year demand for health services outstrips the supply. More money is then demanded, given, and spent on yet more drugs, but quite regardless of this, the crisis continues. The horse is, indeed, dead, and it has been dead for some time. The animal is, after all, over 70 years old, and it has been fed, almost exclusively, on pharmaceutical drugs during all that time! The NHS does not realise this, or if it does it ignores the wisdom of the Dakota Indians, and instead makes use of 'more advanced' responses!

1. Buying a stronger whip.
The NHS believes that it would be able to produce better outcomes for patients if staff could only be made to work harder, to increase their productivity.

2. Changing riders.
The NHS regularly changes it riders, managers are sacked who are just not good enough, and do not spend the money properly. It is important to employ better riders to manage the available resources.

3. Threatening the horse with termination.
The NHS cannot pursue this policy, as unfortunately, in this case, the dead horse has wealthy and influential backers, too powerful to be 'terminated'. However, it regularly terminates some drugs and vaccines because they are so clearly dead, but never the complete animal.

4. Appointing a committee to study the horse.
NHS committees are rife, and have been vital to the NHS development. They study why the demand for health care continually outstrips supply, why offering more drugs and vaccines appears to lead to more sickness (invariably deciding it is due to patients getting older), and to come up with new ideas about how the NHS might function better.

5. Arranging to visit other countries to see how others ride dead horses.
The NHS regularly examines health services in other parts of the world. They usually find there is not much difference because they, too, are trying to ride the same dead horse! But some countries spend more of their GDP on health, so if only they could have more money too......

6. Lowering the standards so that dead horses can be included.
The NHS regularly seeks to lower standards, for instance, nurses doing the work of doctors, hospital beds being reduced, et al. This is not to save money, but to release more money to spend on reviving the dead horse with more pharmaceutical drugs and vaccines.

7. Re-classifying the dead horse as 'living impaired'.
The NHS, whilst hyping the value of every new pharmaceutical drug and vaccine, is at the same time trying to reduce patient expectations. Look at the NHS Choices website to see just how many illnesses and diseases there are for which, we are told, their is no treatment, no cure, no chance of recovery.

8. Hiring outside contractors to ride the dead horse.
The NHS is an inefficient public enterprise, say some, and if more of the work could be contracted out to private companies the greater efficiency would ensure that the dead horse might be able to enhance health outcomes for patients.

9. Harnessing several dead horses together to increase the dead horses performance.
The NHS is constantly asking for new horses, new pharmaceutical drugs and vaccines to help them if their fight against disease. The one's they have may not work, the new ones just might be better.

10 Providing additional funding and/or training to increase the dead horses performance.
The NHS always needs more doctors and more nurses to provide even more health treatment to an increasingly sick population, treatments based, of course, on those that has been offered for decades.

11. Doing a productivity study to see if lighter riders would improve the dead horse's performance.
It is frequently said that the NHS is too 'top-heavy', that there are too many managers and administrators (people who do not give patients the drugs) and not enough doctors and nurses, who do.

12. Declaring that as the dead horse does not have to be fed, it is less costly, carries lower overheads, and therefore contributes substantially more than the bottom line of the economy than do some other horses.
Unfortunately the NHS is totally committed to the most expensive of all medical treatments, so this is a difficult argument to make. However, it does regularly state that the newer drugs costs are too expensive, and that 'generic' cost less.

13. Re-writing the expected performance requirement for all horses.
The NHS has struggled for decades to keep waiting times (for a doctors' appointment, for A&E, for operations, for hospital beds) to a minimum. We are regularly told that unless more money is spent on the dead horse, patients must expect longer waiting times.

14 Promoting the dead horse to a supervisory position of hiring another horse.
Most NHS managers and supervisors are former doctors who have spent their careers prescribing 'dead horse' drugs and vaccines to their patients. Why should they start recognising that the horse is dead after a lifetime of devotion to it?