NHS and competition

Useful BMJ editorial by Chris Ham about competition in the NHS. As he says, the question is whether competition is the right route to take for healthcare.

A "free service for all" was the defining principle of the NHS (Portillo, 1998). The subsequent introduction of prescription charges was intended to suppress unnecessary demand. One problem of the government's latest reforms will be how to control demand when patients have more choice. I suspect charges could well be introduced in the future for what is seen as treatment of a lesser priority. This will have moved us on from the defining principle of the NHS. Aneurin Bevan, minister of health in the Atlee government that introduced the NHS in 1946, resigned because of the introduction of prescription charges.

The NHS has also been a monopoly provider, which the government reforms are intended to challenge. The aim of the nationalisation of health services was to makes services more adequate, in terms of coverage and quality, and more rational, in terms of distribution of resources (Klein, 2006). Because of the kind of commodity health care is, the nationalised model may well fit it better than a free market model. Commercial dependence on the patient makes medicine less objective. Wasn't the NHS created to deal with exactly the muddle of healthcare that the current government's reforms could create?

Poor health care endemic

The Parliamentary and Health Service Ombudsman has produced a report describing the stories of 10 patients who suffered "unnecessary pain, indignity and distress while in the care of the NHS". It may be difficult to draw conclusions from just 10 cases, but she insists these are not exceptional or isolated cases. She does not understand why she needs to hold the NHS to account for the most fundamental aspects of care.
 
Providing basic care is not always easy and straightforward and the NHS would benefit from a re-focusing on the fundamentals. The politics of the NHS can distract it from its basic task. It's even worse when it gets the politics wrong. As I've pointed out before in a previous blog entry, unjustifiably singling out particular services, which may really be no worse than any other, is no help. I've also commented on how this seems to have been the case with mid-Staffs. Hopefully Robert Francis' second report which will be produced from the ongoing Mid Staffordshire NHS Foundation Trust Public Inquiry will take account of the Health Service Ombudsman's findings, and not continue to look for scapegoats.

Writing down thoughts on your mind for everyone to see

I agree with Robert Peston about the value of blogging (see How and why I blog). It's much easier to get ideas out because of blogging. It also can include all sorts of material which isn't going to get published in other media and work in progress. Perhaps this is particularly important for independent minded people like him (and me). And the same standards apply to blogging as other communications.