One of, if not the top priority for health ought to be to reduce health inequalities by the redistribution of resources to those with greatest health needs and to take into account the damage of market rewards where those whose needs are greatest present the greatest challenge to efficient provision.
Despite the rhetoric the emphasis is all about choice of provider, for which there is little evidence of public enthusiasm and absolutely no evidence of any relationship with quality of clinical outcome. One has to assume that this is simply a means of diverting patients to the private sector. My patients today who came to discuss whether to start insulin or continue chemotherapy had far more important choices to discuss than where to be treated.
Patient centred Vs patient led
The two terms are used interchangeably in the white paper. Patient centred healthcare was part of my medical curriculum in the early 90’s, it has helped make enormous improvements in doctor-patient communication even though it remains too often merely an aspiration. Patient led healthcare is political confusion, akin to letting the lunatics run the asylum.
Effective healthcare is a partnership; patient centred and physician guided with shared decision-making.
It’s near impossible for GPs within a single PCT to work together, and yet consortia of 500-600 GPs are expected to joint commission across areas of extremes of social and ethnic diversity and health and economic inequality, e.g. three soon to be abolished PCTs: City & Hackney, Tower Hamlets and Newham, would have to be combined.
GP fundholding widened inequalities between practices because entrepreneurs profited and the less business savvy lost out; it seems likely the these inequalities could be increased in proportion to the enormous difference in scale proposed by GP commissioning. The government’s own Health Committee published a highly critical report about commissioning in March this year, which raised very serious concerns about the poor value for money; scaled up to the level now proposed is fiscally irresponsible.
Rewarding efficiency will widen health inequalities because well educated, motivated patients with uncomplicated needs that are amenable to medical solutions can be looked after efficiently and will therefore attract more resources. Complicated patients with high levels of socially determined health needs, complex medical problems, low literacy and chaotic lifestyles cannot be looked after as efficiently and will lose resources even though their needs are greatest.
This White Paper fails to address our most pressing health needs despite costing an estimated £20 billion a year to implement, its a great opportunity wasted.
We must set limits as to the rmaining principles of NHS are stuck to eg NHS services must be provided accordin g to need and not according to ability to pay, reducing inequalities a la Marmot and Wilkinson and Picket is vital for good health, noone employed full time in NHS should earn from the NHS more than £150,000 per year or 8 times lowest paid.
We must set limits and then we have something obvious to fight for.