Consumer choice in health

Article by John Spiers in the Yorkshire Post about the Darzi review

Another NHS report! Should we be dazzled by Darzi? Does Lord Darzi of Denham’s report on the future of the NHS - the 84-page Final Report of the NHS Next Stage Review, High Quality Care for All fundamentally alter the picture so that the customer is in charge?

Lord Darzi, an eminent key-hole surgeon and in 2007 ennobled as a Parliamentary Under Secretary of State, has certainly significantly shifted the focus of concern. There is a new emphasis on quality and on outcomes including patient’s reports of their experiences. The focus on compassion, cleanliness, dignity and respect is vital, too - if still rather astonishingly necessary after 60 years of the NHS and after years of unprecedented investment. In launching his report at Westminster Lord Darzi said that “For the first time, patients’ own assessments of the success of their treatment and the quality of their experiences will have direct impact on the way hospitals are funded”. This admits some key principles into the debate. He has, too, introduced some financial incentives for providers to respond. These are important issues, and his leadership here is very welcome.

However, we should rigorously apply the tests of consumer control, of competition, and of fully informed customers where the individual is empowered to make choices and the medical professions are empowered in a new rapprochement in a market. We should then assess what is being offered, whether it will work, and what still needs to be done.

Most importantly in the extension of patient choice, does the new vision pass individual financial empowerment to the individual? No. It does not. It proposes to extend personal budgets, but it still does not go far enough. Instead, we have another pilot. Here, 5,000 individuals and families with long-term medical conditions such as diabetes, multiple sclerosis, motor neurone disease, and asthma will be given personal health budgets to give them greater control over the care they receive - “with a view to a national roll-out”. In addition, all 15 million patients with long-term conditions will receive personal care plans. But if the financial incentive principle is right, why not extend it into every nook and cranny of health and social care now? We have already seen the significant gains in social care from the pilots in personal budgets.

Second, does Primary Care Trusts and GPs have to seek the willing revenues from individual holders of health savings accounts? No. They do not. Notably, PCT monopolies - which are state created cartels - remain undisturbed, even if patient’s have the right to choose their GP. The necessary i