The future of the NHS?
As with the post from last week, the issue of resourcing care is in the news again. This time it is about the overall budget for the NHS over the next few years. The comments from politicians that are being reported in the BBC’s coverage emphasise that patient choice will remain a priority, despite what may happen in cutbacks and re-structuring.
But should it be? Should patient choice be a gold standard? What happens if that choice uses resources that could be directed elsewhere? Perhaps we need to start asking some serious questions about the goals of maintaining people’s overall wellbeing and the extent to which these be persued at all costs.
At a time of financial constraint, this could be an opportunity to address the priorities of health care and to establish the parameters of a system that has evolved enormously since its beginnings 60+ years ago. So instead of the news of budgets being cut and frozen being seen as a threat, could this not be seen as an opportunity for renewal?
July 22nd, 2009 at 9:40 am
Good questions indeed! When I needed a small surgical procedure recently the first thing my GP told me with a smile on her face was that I had a choice of hospitals to attend for it. I looked blankly back at her. I didn’t want to have to make a choice, I just wanted treating as soon as possible and safely.
This idea that ‘choice’ is what we want in things like health care and education has gone too far, it confuses the issue by turning them into commodities just like any other in the market place. And not everyone has the opportunity to make equal choices. In things as fundamental as health care and education it shouldn’t be about choice but about ensuring everyone has equal opportunity to access good services. And currently they don’t. But they have choice….!
July 27th, 2009 at 7:29 am
Some of the arguments in favour of choice (check out Julian Le Grand’s work) point out that it is an alternative to user ‘voice’. It is suggested that use of voice – influencing their services through feedback, chats with their GP etc, involvement on boards and committees – favours the educated, the articulate and the middle class. Being able to take your business elsewhere – that is, exercising choice – enables true equity across society. If only it were that simple. Looking at the information I could use to choose a hospital, do I decide to go for the hospital with shorter waiting lists but higher MRSA rates, better food but less friendly staff?
August 7th, 2009 at 9:55 am
Hi,
This is the first opportunity that I have had to look at this blog and I would like to comment on the NHS disucssion about patient choice.
Whilst I am familiar with Julian Le Grand’s work the NHS belongs to the whole of the UK and is actually devolved. Chris has actually said why exercising choice should be ‘true equity’ but is not because of lack of information (disempowering public sector), poor access, discrimination through age, disability, race, culture, gender etc…
I find it continually disappointing that when there is a discussion in UK newspapers, or on the BBC – in particular – or ITV and Channel 4 where the NHS is described mainly within anglo-centric terms.
As a UK university we must not fall into this trap. Whilst we do offer the various different national care policies our courses are still written from the DOH perspective and the other nations’ policies are either in brackets or in the reference list.
The DOH perspective of the NHS is that patient choice is the main driver.
This is not so in Wales where the drivers are Citizenship (so participation and meaningful involvement) and Partnership (hence our policies called “Making the Connections”). These two drive the thinking for real public involvement and raising the level of value-based care (in NHS Designed for Life Strategy and Action Plan) and community cohesion (represented in Social Services – Fufilled Lives: Supportive Communities and Action Plan in the new Community Services Framework).
Thus in Wales the NHS has been reconfigured, we have a new rural health planning consultation in progress at the moment with clear direction on a “Generic Health and Social Care Worker for Rural areas of Wales” and a new NHS Commission reviewing the NHS for the future called the “Bevan Commission”. In fact where the NHS began – with Aneurin Bevan. The large reconfigured NHS organisation for South East Wales is actually called the Aneurin Bevan Local Health Board as Bevan was based in Blaenau Gwent.
We are also recognising the future concerns by producing Action Plans rather than just Strategies – which these days arguably seem to go nowhere. So – there is a new Dementia Action Plan, a Chronic Conditions Model and Framework and of course we have the two Commissioners – Children and the unique Older People Commissioner.
So – in essence can we look at making our course material and discussion more inclusive please through recognising and valuing the differences rather than one model of health and social care.
How I have provided a stimulus for more discussion!!
August 10th, 2009 at 1:33 pm
You have indeed, Lorraine! And thank you so much for your extremely helpful comment. I know this is something that we try to achieve through encouraging individual focused activities on regional and national differences, but there is also room to incorporate a wider comparative perspective into the more generic materials for courses. I for one will certainly be trying to do this!
March 3rd, 2012 at 12:40 am
very nice article, I have been trying to look for this. Thanks! please visit mine too at http://latestbestmovie.blogspot.com