Health Check: `Most of us want high-quality treatment from our local NHS hospital, not a bewildering list of different clinics'
Tuesday 08 February 2005
My father is self-employed, and the crippling attacks caused by the condition had already left him unable to work at times. To wait up to a year-and- a-half for treatment was unbearable, both for him and his family watching him suffer.
So he paid more than pounds 3,000 for private surgery. "I didn't have any choice," he said. "The pain was driving me insane."
But my father was lucky - he did have a choice. Although not rich and without private health insurance, he did have the money to pay for one- off treatment in the independent sector. He was treated within weeks and back at work shortly afterwards. Without that option, his choice was limited to the NHS or nothing.
It is precisely this situation which the Government aims to eradicate, with a transformation of the health-service policy which it claims will be the biggest since the foundation of the welfare state. New Labour's new mantra on health for the forthcoming election will be "choice" - the nanny state or doctor no longer knows best, the patient does.
From December, patients needing elective, non-emergency surgery, will be given the choice of five providers for their treatment. They could include the local hospital, a privately run but NHS-contracted Independent Treatment Centre (ITC), or a private hospital with whom a set tariff for operations has been agreed with the local Primary Care Trust.
For the patient, treatment will remain free at the point of delivery, while funding for the operation will follow them to wherever they choose to go.
In effect, this will make healthcare provision into a popularity contest - if a local hospital has long waiting times or a bad reputation, patients may well choose to go to an ITC down the road. The local hospital will lose money, wards may close, and unless managers pull their socks up, the entire hospital could be shut down.
In five years' time, when the NHS is 60 years old, the patient choice initiative will have been extended so that anyone in the country will be able to choose anywhere to have their routine surgery.
The ultimate Government pledge is that by 2008, no patient will wait longer than nine weeks from the point of seeing their GP and being told they need routine surgery to having their operation.
John Reid, the Health Secretary, says this choice amounts to a radical transfer of power in the NHS from the provider to the patient. While it will ultimately be his hand that signs the death sentence on a local NHS hospital, he says it will effectively be the patients who make the decision, with their choices on where they are treated. Good hospitals with fast access, quality treatment and local support will prosper; failing hospitals will be forced to raise their standards or lose funding.
The private sector, once viewed with such suspicion by former left-wing politicians such as Dr Reid, will now be brought on side, helping to increase capacity and provide another New Labour favourite, diversity of provision.
This alliance has also stymied the Tories in their attempt to gain the upper hand in the health debate. The Conservative policy - to pay half the cost of private surgery to patients if they opt out of the NHS - is still mired in the belief that most people have the means and the will to spend money in the independent sector.
On the surface, Labour's initiative seems much more attractive. But are we really being offered a choice? Dr Reid, a Phd rather than a medic, doesn't seem to like or trust the medical profession very much.
Hospital consultants have raised concerns that they are coming under pressure to refer patients to the ITCs, which have been brought into the fold with guarantees of a set volume of patients for the first five years of their contracts.
When these worries are put to Dr Reid, he dismisses them with accusations that for years doctors have made money by emphasising the long NHS waiting times to patients before offering to do the same operation privately. He insists that it "is the patients who will decide" which hospitals close.
But what kind of choice is it to have the option of a privately run ITC 40 miles away that could treat you quicker, but knowing that your decision could lead to the closure of your local NHS hospital?
Most people want fast access and high-quality treatment delivered by their local NHS hospital, not a bewildering list of different centres, clinics and hospitals all over the country.
By offering us choice, is Labour really admitting that the postcode lottery of unequal treatment and quality in the NHS is here to stay?
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