I've decided to talk today on the title: “Is a patient-led NHS possible?” I went to a conference last October hosted by something called the New Health Network.
It’s run by Margaret Mythen, who was head of policy for the Labour Party for five years in the 1990s. This organisation is driving forward some of the government’s ideas and health secretary Patricia Hewitt gave the keynote address.
Everything she said sounded absolutely perfect, but for me it was just so different from what is happening on the ground.
I suffered a kind of “cognitive dissonance”, which is when your perception of reality is completely different from the pictures you’re being shown.
There is a background to the idea of a patient-led NHS. The department of health published the NHS improvement plan in 2000, after three years of sticking to Tory spending levels, and it was updated in 2004.
Its stated aims were to increase capacity, extend choice and reduce waiting times – all of which are laudable aims.
There were a number of consultations. The “Choice, Responsiveness and Equity” consultation was John Reid’s baby when he was health secretary.
It concluded that people wanted to share decisions about their health and receive the right information, and that services should be shaped around people’s needs.
None of this business of going to a hospital when it suits the people at the hospital – they should work 24 hours a day, like they do in banks and supermarkets, according to someone in the Birmingham consultation.
Then there was the July 2005 Green Paper entitled “Your Health, Your Care, Your Say”, which launched a new consultation. When I attended the New Health Network conference they had the questions they had asked in the consultation. They were so badly phrased.
The one asking people if they wanted annual health checks asked about checking serum cholesterol and blood pressure, and four other checks.
I can see it’s perfectly sensible to check blood pressure every year, because you don’t know if someone is developing hypertension until they have it quite severely and develop symptoms.
But doing a serum cholesterol test on everybody? Is that necessary? To lump these different tests together was just crass.
In March 2005, we saw the publication of “Creating a Patient-Led NHS, Delivering the NHS Improvement Plan”. The 2004 improvement plan was called “Putting People at the Heart of Public Services”.
So between 2004 and 2005 we went from putting patients at the heart of the NHS, which I totally approve of, to a patient-led NHS. The 2005 paper goes on to say things like this: “The ambition is to move from a service that does things to and for its patients to one that is patient-led.”
What does that mean? “These changes are profound.” Absolutely. “These changes are very ambitious.” And the ambition? “To change the whole system.”
We’ve got a really waffly concept being launched on an unsuspecting public. I’ve read the statements on the NHS website about the progress in creating this patient-led NHS, and one thing that is quite odd is that the patient involvement in this patient-led NHS is minimal, if it’s there at all.
The key elements of the proposed changes are patient choice, payment by results and establishing a fixed national price for each procedure.
I was interested to read that they have actually scrapped these tariffs for the moment, because they have accepted that there were major errors in how they worked them out.
In 1989 there was a Tory project called the Resources Management Initiative, where six hospitals were trying to find out exact prices for things.
I know from that experience that we didn’t really know how much things cost. Part of the reason why the US system is so expensive is that every aspirin, every plaster, every drip has to be costed.
There is a threat to the whole NHS from the government’s agenda. In July last year Sir Nigel Crisp, the NHS chief executive, wrote to primary care trusts (PCTs). He wrote on 28 July, just as everyone was going on holiday.
He told PCTs, which receive about 75 percent of the health budget and provide basic services outside hospitals, that they had to become commissioners and not providers of services.
No thought was given to how services would be maintained or the number of staff involved. The Royal College of Nurses (RCN) embarked on a judicial review.
Then in November, Nigel Crisp wrote another statement saying they had reached an agreement with the RCN and they didn’t really mean that PCTs were just to become commissioners.
However, the government is increasingly saying that, although the NHS will still be free at the point of use, services don’t all have to be provided by the NHS. Anyone can do it, as long as they have the right standards.
‘Managers now talk about the NHS as a brand’
New Labour is floating the idea of the NHS as a brand. If you read Naomi Klein’s book No Logo, her thesis is that at the end of the 1980s the big multinationals stopped making things and started using their money to brand themselves, outsourcing actual production.
As someone who has spent their working life in the NHS, when I hear NHS managers talk about the brand it makes me feel sick.
Then there’s another question – do the general public want to lead the NHS? Surveys run by people other than the government show that it’s pretty unlikely that they do. They might want it to be more responsive to the patient, but they don’t want to run it.
There also seems to be a belief in this government that business is more efficient than the public sector. Is business really so efficient? Whenever I do something with my bank I’m appalled by how inefficient things are.
For example, if you let the market drive the food industry you get all sorts of inessential foods and drinks, which lead to obesity problems that the health service then has to deal with.
There is an increasing dominance of the private sector. When you look at the maps on the department of health website of the independent treatment centres (ITCs) it tells you how many operations have been done by the NHS, but it doesn’t tell you how many are done by the private sector.
It’s hard to get the figures. Patricia Hewitt gave a speech in January where she said that they had done 250,000 procedures – half operations, half diagnostic procedures.
But they say that there is an issue of commercial confidentiality. To me that’s complete nonsense in a National Health Service funded by the taxpayer.
You may have heard about the case of one opthalmology ITC, where a PCT had to pay for a large numbers of operations that weren’t actually done, because the patients didn’t want to go there.
Julian Le Grand, a Downing Street policy adviser, wrote in the Guardian that ITCs were more efficient than the NHS.
Well of course they are – if they are not training student nurses and doctors, if they are able to cherry pick the most lucrative and least complicated operations.
You get patients treated like commodities. High risk patients are unattractive, which leads to “patient dumping” as we’ve seen in the US. There is an inability to plan services because patients might choose not to go to your hospital.
You have the involvement of US multinationals – from a country where 45 million people have no health insurance and outcomes for maternal and child health that are worse than Cuba. This is a crazy and expensive system to emulate.
Nobody knows where this is going to end. At the conference I attended, people kept talking about “turbulence” – one of those new buzzwords. A senior NHS manager said, “I want to be a leader in the new NHS, but I’m in the dark. I don’t know where we’re going.”
Patricia Hewitt said in December that the next 24 months will determine what kind of NHS we have for the next 24 years.
“Reform is the solution not the problem,” she said. That’s her view of things, but it’s not mine. I’ve always been more one for the cock?up theory rather than the conspiracy theory, despite my personal experience, but they can’t be as incompetent as they seem to be.
What can we do? I’d ask you all to join the new Keep Our NHS Public campaign, donate money to it and talk to your MP.
Keep Our NHS Public was launched in September last year. We want to build a broad coalition to campaign to protect the NHS from further privatisation and fragmentation.
For more on Keep Our NHS Public, including details of its 25 March conference NHS SOS go to www.keepourNHSpublic.com