ABSTRACT

In the private sector, consultants are paid by fee for service, according to the work that they do. Vested interests have been enthroned within the NHS since its creation. Two things will encourage professionals to consider that change is in their interests, namely greater trust in their professionalism, and direct economic incentives. This requires incentives to encourage individuals to take care of themselves, and to consider the consequences of their behaviour. Incentives are vital if we are to persuade people to do things which they do not believe are in their interests, at least in the short term. Dr William Pickering recommends that copies of all complaints and their written medical responses should be seen by an independent medical inspector who, when necessary, would examine the medical records. This realisation is not in conflict with the fact that patients, too, are not rational desiccating calculators. There is a deep need for mystery, romance, spirituality and faith.