Dr Phil Hammond, broadcaster and GP returner in Bristol

What should Gordon Brown do with the NHS?

What should Gordon Brown do with the NHS? Gordon Brown may want to put his ‘unique stamp’ on the NHS, but Blairites were working around the clock before the prime ministerial handover to progress the market reforms beyond the point of no return. The great con of Tony Blair’s NHS was to preach the rhetoric of patient power, while handing over control, and a vast sum of public money, to the private sector. To argue that this is not privatisation of the NHS is nonsense.

The tipping point for the NHS will come if ‘new’ Labour pushes through its plans to outsource up to billions of pounds worth of commissioning to American firms. These companies have saturated the healthcare market in their own country and see the NHS as a gateway into Europe. The NHS management team is now putting intense pressure on strategic health authorities and primary care trusts to outsource their commissioning. The idea that the trusts will retain ultimate control (and hence keep the NHS public) is a myth.

So what is Brown to do? Clearly a return to the old Labour style of imposing decisions by bureaucracy is impossible. And yet Blair’s model is equally didactic, suggesting market competition is the only way forward and peppering it with promises of choice, when patients only get to choose what the Government wants them to. The junior doctor selection crisis is the most extreme example of this—thousands of doctors who have worked for 7 years or more in the NHS are allowed only one choice in their search for a job, in many cases only specifying a region rather than a hospital unit. Stalin invented the internal market, the Tories introduced it to the NHS, and Labour is polishing it to imperfection.

The NHS works because it is a one-stop shop—once you are in it, you get all the care you need. Contrast this to the situation in America, where patients who have brain tumours removed are sent home the next day if their insurance package does not include continuing care. If American-managed care corporations unleash their ‘expertise’ on the NHS, only an American system can result. Profitable patients are cherry picked, while unprofitable patients are dumped. Worst of all, the first question you ask a patient in the American system is not ‘What can I do for you?’ but ‘How will you pay?’.

Gordon Brown must reverse this policy without seeming to be old Labour. There may be parts of the NHS that needed a bit of competition to shake them up, but splitting a service up into tiny little coded parcels of care is the death of continuity, a bureaucratic nightmare, and a sure road to madness. The solution is to deliver what Blair and Hewitt have pretended to promise already; a devolved NHS, where 80% of the decisions are made locally.

Working in the NHS is like pulling people out of a river without bothering to look at who is pushing them in. If Labour really wants patients to get involved in shaping services, it has to move the money upstream and stop the dysfunctional schism between top-down marketing and local decision making.

Most NHS resources now go on managing chronic illness, and many patients manage themselves perfectly well for all but 3 hours a year, when they are hanging around the surgery. Tapping into this expertise and getting patients to help other patients in their communities is the best hope of stopping the log jam downstream.

The message is simple: local partnerships between patients and NHS staff work, market reforms do not. But will Gordon swallow it? G

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