NHS patients deserve the best

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

Share
Related Topics
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.

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Ashdown Group: Senior Accountant - ACCA, ACA or ACMA - Construction Sector

£45000 - £50000 per annum + Benefits: Ashdown Group: Senior Accountant (ACCA, ...

Recruitment Genius: Media Sales Executive - PR and Broadcast - OTE £35,000

£16000 - £35000 per annum: Recruitment Genius: This company has an exciting op...

Recruitment Genius: Customer Service Advisor - Shifts

£17000 per annum: Recruitment Genius: This European market leader for security...

Recruitment Genius: Freelance AutoCAD Technician

Negotiable: Recruitment Genius: A Freelance AutoCAD Technician is required to ...

Day In a Page

Read Next
 

If I were Prime Minister: I'd champion the young and hold a cabinet meeting on top of Ben Nevis

Bear Grylls
 

i Editor's Letter: The five reasons why I vote

Oliver Duff Oliver Duff
War with Isis: Iraq's government fights to win back Tikrit from militants - but then what?

Baghdad fights to win back Tikrit from Isis – but then what?

Patrick Cockburn reports from Kirkuk on a conflict which sectarianism has made intractable
Living with Alzheimer's: What is it really like to be diagnosed with early-onset dementia?

What is it like to live with Alzheimer's?

Depicting early-onset Alzheimer's, the film 'Still Alice' had a profound effect on Joy Watson, who lives with the illness. She tells Kate Hilpern how she's coped with the diagnosis
The Internet of Things: Meet the British salesman who gave real-world items a virtual life

Setting in motion the Internet of Things

British salesman Kevin Ashton gave real-world items a virtual life
Election 2015: Latest polling reveals Tories and Labour on course to win the same number of seats - with the SNP holding the balance of power

Election 2015: A dead heat between Mr Bean and Dick Dastardly!

Lord Ashcroft reveals latest polling – and which character voters associate with each leader
Audiences queue up for 'true stories told live' as cult competition The Moth goes global

Cult competition The Moth goes global

The non-profit 'slam storytelling' competition was founded in 1997 by the novelist George Dawes Green and has seen Malcolm Gladwell, Salman Rushdie and Molly Ringwald all take their turn at the mic
Pakistani women come out fighting: A hard-hitting play focuses on female Muslim boxers

Pakistani women come out fighting

Hard-hitting new play 'No Guts, No Heart, No Glory' focuses on female Muslim boxers
Leonora Carrington transcended her stolid background to become an avant garde star

Surreal deal: Leonora Carrington

The artist transcended her stolid background to become an avant garde star
LGBT History Month: Pupils discuss topics from Sappho to same-sex marriage

Education: LGBT History Month

Pupils have been discussing topics from Sappho to same-sex marriage
11 best gel eyeliners

Go bold this season: 11 best gel eyeliners

Use an ink pot eyeliner to go bold on the eyes with this season's feline flicked winged liner
Cricket World Cup 2015: Tournament runs riot to make the event more hit than miss...

Cricket World Cup runs riot to make the event more hit than miss...

The tournament has reached its halfway mark and scores of 300 and amazing catches abound. One thing never changes, though – everyone loves beating England
Katarina Johnson-Thompson: Heptathlete ready to jump at first major title

Katarina Johnson-Thompson: Ready to jump at first major title

After her 2014 was ruined by injury, 21-year-old Briton is leading pentathlete going into this week’s European Indoors. Now she intends to turn form into gold
Syrian conflict is the world's first 'climate change war', say scientists, but it won't be the last one

Climate change key in Syrian conflict

And it will trigger more war in future
How I outwitted the Gestapo

How I outwitted the Gestapo

My life as a Jew in wartime Berlin
The nation's favourite animal revealed

The nation's favourite animal revealed

Women like cuddly creatures whilst men like creepy-crawlies
Is this the way to get young people to vote?

Getting young people to vote

From #VOTESELFISH to Bite the Ballot