RARELY are anniversaries marked by anything more substantial than symbolism and a chance to commemorate, or give vent to collective commiseration of, a past event. But the publication of plans for the foreseeable future of the National Health Service stamps the 60th anniversary of its creation with a tangible milestone, albeit with some brightly flashing hazard warning lights.
Overall, the proposals and the accompanying reviews are big steps in the right direction while the founding principles of the service remain intact. But the ever-widening open door to private profit begs speculation on how long the principles will remain when measured against abiding practice, notably in the area of general practice. “Polyclinics” – a pejorative word latched onto and wielded by the Tory/British Medical Association alliance – are not a bad thing per se. Health centres, as they might more properly, but in a more pedestrian way, be called provide a range of services in one place and, in London at least, should not threaten the link with GPs. They are not a suitable model for rural areas and are not meant to be. However, the opportunity for doctors to both entrench and widen the involvement of profit interests has been greatly enhanced.
The terminology which runs through the report reflects “new” Labour’s obsession with the market: “choice” makes a familiarly strong showing, “personalised care” is there again, while patients will be able to “decide” for themselves from, a new arrival, information “dashboards” in hospitals and GP surgeries. Choice is good so long as it does not mean increased costs on running an internal competitive market with resources that should be used for care. We should heed the warnings from the frontline of commodification from GP Dr Janice Tate on page 14. Her fear that an NHS GP will be a thing of the past in the near future may be overstating the threat but the crawl of private profit business centres into the service has just been given the chance to change gear.
However, there is a decisive break from “new” Labour thinking in the rejection of ideas, such as that championed by former Health Secretary Alan Milburn, of handing the hospitals back to local authorities. Localisation would increase the postcode lotteries which Lord Darzi and Alan Johnson are attempting to end. The embedding of patient rights and quality of care – without the involvement of lawyers – in a constitution is a big and overdue step. There is a view that a constitution is unnecessary. That view is not widely held among those who take seriously the possibility of a Conservative government after the next election. Any future Tory government would have to repeal the legislation if it wanted fundamentally to change the character of the NHS and introduce wholesale privatisation, as they surely would in spite of David Cameron’s feint of embracing the core principles of the service.
The proposals should be a defining factor between Labour and the Tories, its trump card, as Suresh Pushpananthan argues on page 16. Mr Brown and his colleagues will have themselves to blame if, as David Mills predicts on page 25, the NHS loses its potency as a means of differentiating between Labour and the Tories.
Ultimately the report must be judged not on electoral advantage but on what it delivers for those in need of health care. There is much to be optimistic about the intentions behind most of the proposals in the Darzi report, but also much to be worried about its potential unintended consequences. As John Lister points out (pages 9-11), nowhere in the world do for-profit private sector companies deliver equivalent services at lower cost than the public sector. As Oli Usher reminds us on page 17, there is no need for us to fear change but we must be vigilant. In examining the detail of the original blueprint for the NHS, he wryly suggests that Nye Bevan and Lord Darzi may have more in common than might first be apparent. So what would Nye think?
What he famously and bravely said 60 years ago applies now: “We shall never have all we need. Expectations will always exceed capacity. The service must always be changing, growing and improving – it must always be inadequate.”
