DH consultation on greater choice and control: a sham.

I completed the DH consultation on greater choice and control yesterday. It is available here

It says the target audience is (from the top) GPs, nurses, health visitors, clinicians, managers… and way down at the bottom, at number 16, patients, then carers and finally, ‘service users’

The consultation has 57 questions, and about 100 pages, not including supplementary documentation, a glossary and related links. It took me about 2 hours to complete without reading any supplementary information.

Questions 1 to 56 were variations on the following:

Choosey patients like to choose and are choosey about their choices. If you could choose, what would you choose to ensure choicey patients have choosier choices?

Question 57 said (more or less)

Can you forsee any problems with our obesession with choice?

I’ve written about the problems with choice before, the problem with patient choice, more problems with patient choice, and yet more problems with patient choice

But the problem with I’m concerned about here is the problem with consultations. I’ve committed myself to campaigning for a fair, equitable, public NHS which means doing everything I can to stop governments of any political persuasion from transforming a public service into a private business, and consequently made time to fill in this consultation.

But I know that none of my GP colleagues, most of whom feel as strongly as I do about the NHS will have time. I cannot imagine many nurses, health visitors or patients completing it either. Every day amongst my pile of post as thick as a telephone directory and about 50 emails, I am sent a few questionairres. Most of these promise that it won’t take more than 10 minutes.  Commercial organisations sometimes offer a cash incentive if I complete them promptly. I ignore all the commercial ones but usually I fill in ones that are relevant to my patients or research we are involved in, but it really helps that they promise it won’t take more than 10 minutes. Nevertheless I rarely leave work before 8.30pm.

No way are GPs going to fill in this consultation. In the balance between our patients and our families, there simply is not enough time.

There are other reasons.

Firstly, I only heard about it on Twitter. Most GP’s don’t check Twitter.

Secondly it is a sham. 56 questions start with the stated assumption that the only thing better than choice is more choice.

Thirdly it is patronising. A lot of questions imply that doctors have never offered patients choice before, but only now, thanks to the governement they will be forced to start.

Fourthly it is ahistorical. Before the internal market was introduced in 1990 a GP could refer their patients to any consultant within the NHS. Now that the NHS has an internal market that is impossible because of the crazily complex financial arrangements. In this respect it can only get worse

My guess is that less than 0.01% (roughly 300) of GPs will complete this. Thanks again to Twitter I believe that parliament will be asked after the consultation how many GPs have responded.

We should all ask how much money is being spent on these sham consultations, who is responding and what difference they make. My impression is that they make no difference at all, and like my colleagues I should have spent more time with my family.

Update 25.01.2011

Only 200 GPs responded out of approximately 33000 (unofficial communication) If the govt tries to justify any consultation in future remember to ask who responded.