NHS patients deserve the best

Robert Winston explains his plan, favoured by Tony Blair, for centres of medical excellence

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Within a few miles of my own hospital, Hammersmith, an in-vitro fertilisation (IVF) unit has just opened in a National Health Service hospital. This hospital has no specialist infertility consultants and certainly could not provide truly comprehensive infertility care. Recently, the hospital concerned was interviewing candidates for the post of embryologist. One, rather boldly, asked how the unit intended to compete, "seeing as the Hammersmith Hospital, with its world-class facilities, is on your doorstep". The reply was: "We intend to undercut their prices."

As it happens, I do not believe Hammersmith's prices could be undercut. It is actually one of the cheapest units in the country. But what will be the consequence of another clinic on our doorstep? First, there will be another IVF unit in London - which, frankly, is unnecessary. Second, within a year or two, this unit will become unprofitable and close down - but not before considerable NHS resources have been spent on commissioning it and maintaining its staff, and not before far more patients than necessary are likely to have failed a treatment that would have been better administered in the larger unit.

IVF is a relatively minor, rather uncommon treatment, but this experience of threatened waste and the destroyed hopes of ordinary patients is a model for what is happening in the NHS in many different areas. The internal market is increasingly failing to provide the best treatment and wasting ever bigger sums of money.

This country has a health service envied around the world. Apart from its ability to deliver high standards of medicine, it has consistently been at the forefront of developing medical techniques and treatments.

Given the pre-eminence of British medicine, then, why has our Government more or less completed the introduction of so radical a reform? The fact is that the system was creaking. It was economically wasteful at a time when the costs of delivering high-quality care were rising; it was often unaccountable to consumers and unprepared to audit its results; waiting lists were sometimes overlong and the general surroundings for patients often well below the standard acceptable in a civilised society.

The Government established the internal market to counteract these problems. Local health "purchasers", with responsibility for the care of their local populace, were given a pot of money to "buy" the most appropriate medicine for their people from "providers". These, mostly the local general hospitals, were able to compete with each other to "sell" their clinical wares. This reform, whose impact and implications are still barely understood by at least 95 per cent of the patients I see in clinics (and by a surprising number of my own colleagues), was revolutionary.

The internal market has ensured to some extent that providing hospitals have improved efficiency: waiting lists are a bit shorter; hospitals tend to be brighter and more anxious to please. But there is a growing awareness that the internal market is damaging much of the real fabric and core of the NHS.

Centres of excellence, such as my own, used to be able to offer specialist medicine at the highest level to patients from Aberdeen, Belfast or Bury. Now you can live on one side of the street in London under one health authority and get treatment, or live on the other side - under a different authority - and not get treatment.

This fundamental inequality goes against the whole concept of the NHS. The ability of centres of excellence to undertake large numbers of specialist procedures generated clinical research that was the envy of all our American colleagues. It also led to excellent training for junior staff, who received the best clinical education in the world. This excellence influenced care in all centres distant from the regional or teaching hospital.

This is part of Tony Blair's vision for the future. He recognises that regional centres, threatened and weakened by the Government, should play a leading role in reshaping the NHS under new Labour. Such centres provide a cost-effective and excellent way of providing what is best in British medicine.

By connecting them to the Information Superhighway, using it to transmit any material that can be digitised from doctor to doctor (X-rays, monitored traces and ultrasound, for example) and by linking live operations, they would have a new role in improving treatment and education, as well as increasing standards for the next century.

Robert Winston is professor of fertility studies at Hammersmith Hospital.

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