Jill Palmer - Prescriptions

FIRST we had community health councils as the patient and public voice of the National Health Service. These local independent consumer councils, once heralded by Labour as “a powerful forum where consumer views can influence the NHS and where local participation in running of the NHS can become a reality”, ran successfully for 28 years until they were unceremoniously dumped by the Government in 2003.

Then we had patient and public involvement forums. These independent bodies replaced the popular CHCs with the remit to “involve local people in monitoring NHS services and in decisions about local health services”. This remit sounds virtually identical. Now, less than five years later, they, too, have been abolished. As from next month, yet another new patient and public voice is being introduced by the Government. These are local involvement networks (LINks).
According to the Department of Health website, LINks will “provide everyone in the community with the chance to say what they think about local health and social care services – what is working and what is not; give people the chance to influence how services are planned and run; feedback to services what people have said about services so that things can be improved”.

That’s very similar, if not identical, to the role of the original community health councils whose job was to: “provide local people with the chance to say what they need from the NHS and represent their interests when changes are proposed to local health services, challenging plans for changes which are opposed by local people; give people the chance to identify good practice and make proposals for improvements to the NHS; collect information by visiting hospitals, clinics and other NHS premises to assess the standard of care.”

Isn’t this just change for change’s sake? What was wrong with community health councils in the first place? They had public support, patients knew where to find them and the medical profession respected them. They gave patients and the public a good chance of involvement and engagement with the health service – which this Government is totally obsessed about. Is there any likelihood that LINks will be better than PPI forums? Is there the remotest chance that either is better than the original CHCs? How much money has been wasted?

In fact, the amount of money squandered on this issue will be peanuts compared to the amount of money that is about to be frittered away on advertising. Yes, advertising. From April 1, NHS hospitals have been given the green light to spend money advertising their services. Not on patient care, but on telling patients how good their care is. Desperately-needed funds will be diverted from looking after patients into the coffers of advertising agencies.

It all fits in with the “Patient Choice Initiative”, which says that anyone can now choose to go anywhere in the country for non-emergency treatment and operations, including private hospitals that are NHS-approved. And how would patients – or, for that matter, GPs – know which hospital to go to? By reading its advertisements, of course. Hospitals will have to step up the promotion of their services in a bid to attract patients, competing with each other for customers.

Incredibly, there is no official cap on how much can be spent on advertising. Although according to The Code of Practice for Promotion of NHS Services, hospitals and other service providers “will be expected to recognise the potential effect on the reputation of the NHS of disproportionate expenditure on promotional activity. The cost of TV or cinema promotion is very unlikely to be justifiable.”

So it is just going to be hospital advertising on local radio, in newspapers and magazines and on billboard hoardings, is it?

Just as incredible is the fact that it is deemed perfectly permissible to knock other service providers “in the interests of vigorous competition and public information”, so long as comparing your services to theirs: “is not misleading; services for the same needs or intended for the same purpose are compared; one or more material, relevant, substantial and representative feature(s) are compared; no confusion is created between the service promoted and the services of a competitor. Well, that’s all OK then, isn’t it?

Hospitals will also be allowed to send direct marketing to their patients so long as it does not “cause fear or distress without good reason”. And promotional aids to encourage business – in other words, persuade GPs to refer their patients to your hospital or independent treatment centre – are also allowed so long as they are “inexpensive”. The new code has even set a cost limit:
£6 excluding VAT.

What can you get for £6 plus VAT? The code helpfully suggests “stationery items, such as computer accessories for business use, pens, pads, diaries and calendars, and clinical items such as nail brushes, surgical gloves, tongue depressors, tissues and peak flow meters” as gifts for health professionals, administrative staff and commissioners.

But don’t be concerned that all this advertising and promotion of the NHS will undermine its ethos and principles. There is a paragraph in the code covering that as well. “No promotional activity should be undertaken that undermines the reputation of the NHS, NHS logos or trademarks (or services supplied under those logos or trademarks) or otherwise brings the same into disrepute.” The code also stresses: “Promotional activity should not undermine public confidence in the NHS. The logo is trademarked and may not be used by providers to promote non-NHS services or products.”

Although even the code admits: “In practice, there will, of course, be occasions when it is difficult to distinguish between promotional material aimed at NHS and non-NHS patients and, indeed, this material may influence patients whatever sector they are treated in.” In a nutshell, this means that vital NHS money – which is spent on advertising rather than treating patients – could well be attracting private patients and increasing private business. And who is going to make sure that advertisers stick to the rules and don’t give GPs a £10 pen as a promotional gift; or advertise on television; or compare themselves too favourably with other hospitals? The primary care trusts, of course.

After all, they haven’t got enough to do planning, delivering and purchasing care for their local residents. They have plenty of time and inclination to act as enforcement officers to ensure everyone adheres to the code in the right and proper manner. And it they run into trouble they can always turn to the
Co-operation and Competition Panel – although that won’t be operational until October.