No decision about me, without me

..and other fairy tales. From the Conservative party manifesto

“putting patients in charge of making decisions about their care”
is the choral refrain, and yet this week has seen a new Health and Social Care Bill which, bottom line, seeks to interrupt and decimate relationships between  patients, GPs and hospital specialists by putting numerous other messy and unanswerable systems in instead.

There is no evidence that putting in private companies to the NHS does anything useful. The new reforms will make it all worse – why can we not realise that ‘competition’ does not work everywhere? Why can we not realise that the profit motive is not the best way to run a healthcare system? Would you please, Mr Cameron, look at America?

The ‘no decision about me, without me’ is the kind of  refrain which politicians love. It’s a bit like being ‘anti-cancer’ – of course you can’t be pro-making-decisions-without-patients. But look at the detail: it’s the inherent opposite. Instead of a patient and a GP sitting down together to discuss what needs done and where, a shifting market of budgets, fundholding, and ‘pathways’  means that people who don’t have the ability, the will or the advocacy to fight for their corner will lose out.

What an absolute disaster. Up will rise various competitors to the NHS, all wanting a bite at the cherry. And all will come with strict limits on what they will or won’t do, what complications they will or won’t cover. The joined up system where one specialist can ask another for advice will be replaced (if it hasn’t already) with a system where no consultant-to-consultant referrals are allowed, and delays and inconvenience are enjoyed as a potential cost-saving is stacked up. Bad news for patients. Bad news for doctors trying to do a good job. When did they ever get to make this ‘choice’?

Didn’t the conservatives say that they were against (yet another) NHS reorganisation, pre-election? Why do they think they can make a health market system work when it never has, and when Obama is trying his best to reverse the tide?

8 Responses to “No decision about me, without me”

  1. David Colquhoun January 22, 2011 at 11:17 pm #

    Well said.
    It is the same with universities. The changes are entirely old fashioned top-down management by politicians, It is very hard to escape the conclusion that they result from Conservative ideology, and have very little to do with medicine or education.

  2. jonathon tomlinson January 22, 2011 at 11:43 pm #

    A pleasure in these dark times to discover your blog, j

  3. Andrea Franks January 23, 2011 at 8:46 am #

    Absolutely right.
    This is about the end of the NHS, as so much money will be wasted on managerial costs (all those contracts, coding, executive pay, private sector profits….) that comprehensive care will be impossible.

    This appears to be what is intended,
    and goes along with selling off the royal Mail, privatising education, selling off public forests and so on.


  4. Margaret McCartney
    margaretmccartney January 23, 2011 at 4:35 pm #

    There’s a fantastically funny bit in the’The Real nhs – A marketing approach’ from the Institute of Marketing a couple of years ago when they wrote this

    “Margaret McCartney is certainly not alone in fundamentally misunderstanding the role of marketing and the benefits it can deliver. She speaks of “glib,
    meaningless statements” and paints a picture of an
    organisation “shattered into pieces and forced to waste its resources to compete with itself” The Unions too are not slow to join in: “The very idea
    that hospitals should spend taxpayers’ money on advertising for patients instead of treating patients is ridiculous” states Karen Jennings, Head of Health
    The real NHS: the benefits of a marketing approach Exploring the issuesat the public services union Unison, again seemingly betraying a lack of understanding of what marketing is actually about.
    Are these the views of neoLuddites who need to be shown the light, or are they vital stakeholders who need to be embraced? However the views
    are seen, they represent a broad spectrum of the organisation’s
    employees and clearly represent a challenge for marketers within
    the National Health Service.”

    They have absolutely no idea of what the NHS is meant to do. but they are ready to start picking at the profits to be had.

  5. Dr Grumble January 29, 2011 at 5:44 pm #

    What is taking place is the tragic end of the NHS. It is bound to cost more and the care is likely to be worse. You are charitable in suggesting that the marketing fraternity have no idea of what the NHS is meant to do. The alternative explanation is that this process is being driven by greedy people whose only interest is in making money at the expense of the hard-pressed taxpayer.

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  7. Hamiltion December 25, 2011 at 4:26 am #

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