Shopping in the NHS

As they gear up for the next general election, New Labour and the Tories are competing to see who can offer more ‘choice’ for patients in the health service.

New Labour had promised that by the end of 2005 people would be given a choice between four or five hospitals for their operation. The Tories trumped this by saying that they would allow people to choose any hospital for treatment. (It is now thought that Labour will respond by giving people the choice both of the hospital and the specialist) (1).

Health secretary John Reid is expected to announce that doctors’ surgeries will be located in train stations and supermarkets, to fit in with busy commuter lifestyles (2); and that there will be more focus on enabling people with chronic diseases to be treated at home if they wish. Meanwhile, the Tories will allow people to choose between private and public treatment, footing 60 per cent of the national health service (NHS) cost for an operation if a patient decides to go private (3).

This scrap about choice in the NHS is entirely an invention of the political elite. Most people just want to get their health problems sorted out quickly and easily at a good local hospital – they don’t care if they see Dr Jones or Dr Smith, at St Thomas’ or Barts. Personal medical treatment is really a technical matter rather than a political choice – the precise way in which you get treatment for your kidney infection is not important, so long as it is done competently and with as little hassle as possible.

The likely reason for politicians turning this into an issue is to try to breathe life back into the corpse of parliamentary politics, at a time when voters are turning away in their droves. Perhaps the idea is that voters might not be turned on by ‘big’ political issues, but they can’t fail to take an interest when their own health is at stake. When you’re on your sickbed, is the implication, you can’t just turn off and say that you don’t care. So you are given options of different kinds of medical treatment, and told that this is what politics is about; being an engaged citizen is redefined as deciding where and how your body gets patched up.

This turns political choice and citizenship into something that is utterly banal, and is more likely to turn people off than on.

The model for this is less the maelstrom of political life, where important issues are debated and fought over, than the bland choices you make as isolated consumers. ‘Choice’ here doesn’t even mean deciding how to organise the NHS as a whole – deciding how much money should go into it, or whether everybody should get free prescriptions, for example. At least this would be a discussion that would affect the service that every individual has to deal with. Instead, we get to choose between the cans of beans that are already on the shelf, or rather a series of equally mediocre hospitals. This assumes that the important decisions have already been made; we get to ‘choose’ within a framework that has already been decided.

Meanwhile, political parties become reduced to something like the managers of a supermarket, competing to tempt the public with needlessly different permutations of chocolate bars. Just as you can choose to have KitKat in chunky, regular, or kubes, you are offered the choice between different hospitals, consultants and treatment locations. This isn’t something that it is possible to develop a distinctive political line on. When all the parties are offering more choice, there is no such thing as a ‘Labour’ or ‘Conservative’ position on the matter. Instead, what we see are parties falling over one another to offer choices that you never asked for. Choose your waiting room! Choose to be treated on the bus! Choose a consultant of your own religion!

While politics will be all the poorer for this, so will healthcare. The problem with the NHS is that the system is moribund and demoralised, not that there isn’t enough choice between hospitals.

Introducing all these bogus choices into the NHS will make the system even more chaotic, and less capable of managing resources and organising efficient treatment for the population as a whole. You’ll have patients spinning from hospital to hospital, and doctors wasting their precious consulting time advising the patient on his or her options. For the patient, being offered options of consultants and hospitals that you know nothing about is likely to mean that your treatment is more troublesome, making you worry about something that you just rather were over as soon as possible.

It would be better to have a decent political debate about the things that matter, and a decent health service for all, rather than all these health options that nobody ever wanted in the first place.

(1) ‘Government u-turn to let patients choose their own hospitals’, Daily Telegraph, 22 June 2004

(2) ‘Labour plans health centre to suit commuter lifestyle’, Scotland on Sunday, 20 June 2004

(3) Howard stresses ‘right to choose’, BBC News, 15 June 2004