Here a Quago, there a Quango,....

I have a couple of patients who need rare and expensive drugs. In my fantasy world, the specialist, patient, and GP could prescribe this - and, as mature responsible adults, the doctors could perhaps be trusted to agree what steps needed to be taken to protect the patient, and by whom.

Sadly, life is not so simple. A whole array of people sit on committees to decide whether a drug is one that GPs should prescribe. Expensive people. People who presumably believe all GPs have identical compentencies. My patients pay for NICE (national), MTRAC (regional), and local PCT prescribing committees. These all agree I should not prescribe these drugs.

All well and good, except - these drugs are expensive, so either the hospitals send patients home with a supply for all of seven days, or the patient's treatment needs to delayed for some months while all the relevant bureaucrats agree to give the hospital the money to pay for the drug (and they do always agree eventually, although sometimes the Sun pushes the Government to push the PCT to tell the committee to say yes....). In either case, the NHS deliberately leaves the patient up a money-saving creek with only a GP as a paddle.

In the meantime, we poor GPs write lots of unneccessary letters - and either obey the instructions from on high (and watch the patients become ill, their transplants fail, complications ensue) , or ignore the bureacracy and prescribe it anyway (and await flak from above)

Which would you do?

Given that the structure of the NHS routinely forces clinicians to ignore the guidance from high ivory towers a long way from reality, and that most of the guidance issued is a 'motherhood and apple pie' regurgitation of existing guidance, how many of these bodies do we actually need?

There were officially 849 Quangos in 2003 (plus more in Scotland, Wales, Northern Ireland)
Sadly, that doesn't include 43 Non-departmental Public Bodies in the Health field, and presumably excludes hundreds of others in other fields.