03 Mar 2011 01:40
Yesterday, the Health Secretary for the UK announced that 2/3 of the UK will start to benefit from more personalised care as General Physicians step up to meet the devolution of the NHS’ administration to local providers. He also said that he was thereby handing power to patients and that it was a bottom-up response. Unfortunately, none of Mr. Lansley’s ideas relate in reality to patient-empowerment or personalised services; the White Paper “Equity and Excellence: Liberating the NHS” itself had no idea how to deliver standards in practice or even require the necessary changes in GP services to ensure health-outcomes that are meaningful and sustainable. The Tuke Institute’s Response to this White Paper was clear and thorough on these issues. Without such basic changes, there can be no “personalised care” that will make any real difference. And I don’t think any reasonable person would think that a diktat from Whitehall could ever be considered a bottom-up approach, especially when the ‘bottom’ constitutes the service-providers’ needs, not the public’s. It is another game of political football—this time against bloated managerialism rather than bloated medicalism. When managerialism was brought in originally, it was to deal with the problem of excessive costs in physician services. Now that managerialism has failed to contain that—largely due to the fact that cost-effectiveness without reference to health-effectiveness is meaningless and a commercial model only understands a financial bottom-line—the British government has swung back to embrace physicians … and privatised services. It is as useful as switching seats on the Titanic in an effort to stop the ship going down. Nothing has changed; physician-centred services are still as financially wasteful; clinical professions still have no idea how to share power and responsibility with patients (nor a wish to do so); and the ship is still going to be sunk by the costs of chronic illnesses.
New vision is needed, a new understanding of the obstacles to delivering health-effective services, and new forms of public participation in treatment, audit, and governance. Just as outlined in the Tuke Institute’s primary paper (see here). Perhaps one day, the Department of Health will listen up and do its job rather than play political games. For those of who are having to fend for ourselves with chronic illness in the absence of effective services, this could not come quickly enough.