Chris Haskins: I could choose a hospital to treat my cancer. Could you?

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The Independent Online

A few months ago I had a problem that concerned my GP - and me. I opted "to go private" because I believed that the process of diagnosis would be speedier, which it was. Thanks to my company's health policies, I have been a member of a private health scheme for 40 years.

A few months ago I had a problem that concerned my GP - and me. I opted "to go private" because I believed that the process of diagnosis would be speedier, which it was. Thanks to my company's health policies, I have been a member of a private health scheme for 40 years.

When, incidental to the original problem, I was diagnosed with prostate cancer, I found out that a new treatment was available in certain hospitals, but not in my area. I again decided to pay, to see a consultant in another area about the possible use of this process for my condition. We agreed that it was not for me, and that radiotherapy was the answer. I then learnt that there was an innovation in radiotherapy, which was not available in all NHS hospitals. Fortunately my local hospital had it, and as a result I will now be receiving my treatment in the NHS, at a local hospital.

The Government believes that we should be treated as consumers when we use what are our own public services, and that we should exercise choice about which product suits us best, as we do in the supermarkets. But the supermarket experience cannot be translated into the public services for the following reasons:

Market choice works only when supply is in excess of demand. When there were shortages of food during the war, rationing was introduced. The only "choices" which were exercised were through the black market. There is virtually no oversupply in the provision of health and education; if there was, there would be a campaign against outrageous waste of public resources.

Markets work properly only if businesses are allowed to fail, because consumers will not buy their products. It is inconceivable that the Government would allow a hospital to fail because people would not use it. In such a situation, the Government would intervene to "save" the hospital, thereby undermining the effectiveness of the market. The British car industry suffered because the weaker players were kept in business through futile state subsidies.

Generally markets work properly only if they are based on cash transactions, so if consumers buy my products and pay a proper price I prosper, but if they do not I go bust. Quite rightly, no cash transaction is proposed by the Government in the provision of public health and educational services.

It is interesting, however, that in Sweden, which has a much stronger public services ethos, people pay for an appointment with their GP (although poorer patients can claim a refund).

The one area in the British National Health Service where people can make a choice is in the selection of their GP. But very few go out of their way to make that choice, which suggests that it is not a patient priority.

I was able to exercise choice to speed up the process of diagnosis because, through my company, I could afford to do so. When a serious health problem arises many poor people will go private if they believe it will help them. The solution must be to make sure that everyone can get a rapid response where there might be a serious problem. Nor is the exercise of choice an appropriate way of accessing new technology. The proper solution is to make it available in all hospitals.

If the local NHS provides quick diagnosis, and has the most up-to-date technology, there remains the question of the quality of the service available, but it is difficult for patients to make assessments about the expertise of their doctors. There has been a suggestion that league tables of performance might be made public, but this would discourage surgeons from carrying out high-risk essential operations, for fear of losing league points. However, all NHS trusts now offer patients the right to a second opinion. The person who is best placed to exercise choice on behalf of the patient is the GP, who, when practicable, does that at present. There is a strong case for strengthening the GP-patient relationship so that the former can get more involved in helping the patients get the treatment that suits them best.

The Government, therefore, rather than putting forward new, flawed "consumerist" policies for public health, should concentrate on what it has been doing successfully in the past few years - providing more staff, and better technology and improved facilities which are available to everyone, without undue delay.

Lord Haskins is a former Blair adviser and ex-chairman of Northern Foods

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