The Choice is Yours - The NHS at 60

'This year is the sixtieth anniversary of the founding of the National Health Service' Nosher announced, as we set out our deckchairs at lunchtime on the small patch of grass outside his allotment shed. 'And whilst it is well known that the middle-classes make far better use of it than the working class, the current policy directives stress the mantra of patient choice, which is again something the middle classes will make much better use of.'
As we sat down and surveyed our little plots, now a great mass of vibrant greenery, some already providing us with food, I wondered what the founders of the NHS would think of it now.
'Tomorrow my wife is off to Shepton Mallet hospital to have her knee looked at' I said 'because the waiting list in Bristol is much longer. But it's an hour's drive (much longer on public transport), and clearly only those with money, personal transport, and lots of free time could possibly make use of this choice. The alternative, for those with little money, no personal transport, and little free time, is waiting for an appointment at Bristol, which could take many months longer. This clearly discriminates against the poor, the elderly, and those, such as the disabled, who may not have easy access to suitable transport. Yet according to the current mantras being trotted out by the Department of Health, this situation constitutes a success. It's a most peculiar distortion of the original aims of the NHS.'
Nosher smiled.
'Not when you think about it' he said. 'The NHS was forged during the great upsurge of communitarian sentiment at the end of the Second World War. The public could easily be swayed by appeals to build a better country for all, rather than for the few. That communitarian sentiment has largely evaporated now. Today buzz-words like 'choice' get a much more positive response from the public, partly because the traditional working class is much smaller than it used to be, and also because the middle classes are the ones who use the NHS most effectively and care better for their health than the working class. So middle class issues such as 'choice' are now top of the political agenda, rather than making a policy issue of treating more effectively the ills that characteristically afflict the working class.'
'Still, I can't help feeling that for choice to be available, there has to be an overcapacity in the system' I replied 'otherwise it's just a case of moving people around to different slots, and the ones who will lose out are those least able or willing to make use of the opportunity to express and act upon their choice, so they'll end up with the worst deal, assuming that choice is about getting the best deal. And buying treatment for NHS patients from independent providers, which is becoming increasingly common, seems to be a way of privatising the NHS by the back door.'
'Which is perhaps why the government claims to be putting more money into increasing capacity in the NHS' said Nosher 'yet if there is an overcapacity in one area to maximise choice, there is immediately a conflict of interest between effectiveness and efficiency. Providing too much capacity in one area means that, with a finite budget, there'll be less capacity somewhere else. And what about mental health? This is an area where choice is entirely absent in terms of treatment options unless you go private, because in the NHS there's far too little capacity anyway to meet the assessed mental health needs of the nation. So choice is a red herring.'
'I can't help feeling the NHS is slowly being privatised by NuLabour' I said 'but I'm not sure the Tories will do it any differently when they get back into power.'
'Whatever happens' Nosher declared 'you can be sure it will be trumpeted by its proponents as a great success, even if it isn't.'
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