FIRST, and most crucially of all, there needs to be an acceptance that the private sector doesn’t have all the answers.
I suppose it was inevitable that a coalition led by Tories would perpetuate New Labour’s article of faith that private provision must always be better than public.
But it isn’t – we have now seen enough examples of private sector involvement in health care to know that it frequently results in waste, duplication and poor quality.
If you want confirmation of that, you only have to look at the billions of pounds still being poured into the pockets of the major IT companies that have completely failed to fulfil their contracts to provide computerised health records for the NHS.
You would think this would be enough to temper Andrew Lansley’s enthusiasm for selling the NHS piecemeal to “any qualified provider”. No.
In fact, he has now revealed that the new commissioning groups – supposedly to be clinically-led, and the centrepiece of his “reforms” – will be hived off to private companies once they are set up, and medical input will be minimal.
The end result of his Health and Social Care Bill will be fragmentation of services to the detriment of patient care.
The fact that it will probably also mark the end of his ministerial career, if current rumours from Whitehall are to be believed, will be scant consolation.
Point two. There needs to be a re-think on the obsession with patient choice.
Now, it’s obviously a good thing to involve patients in choices concerning their treatment wherever there are genuine choices to be made.
The trouble is that patient choice has become the unthinking mantra of all the political parties when decisions have to be made concerning health care provision, and it isn’t always the best way to determine resource allocation.
Take Walk-in Centres (WICs) – the city centre surgeries set up by the previous government because patients, especially commuters, wanted more choice in how they accessed GP services.
At the end of November, this newspaper reported that the Leeds WIC in The Light was closing down, along with others in Manchester, Newcastle and London. The reason? The centres were under-used; only one in five attendees was a commuter, and most of the others were already registered with GPs in Leeds.
This was predictable, and predicted, but focus groups “wanted” the additional facility, and so it was provided. NHS Direct, the telephone helpline, was provided for the same reason, diverting highly trained nurses from the front line, where they are sorely needed, into call centres where they contribute little or nothing to patient care.
You see, it’s that duplication and waste I mentioned in the first item on my wishlist.
If we had unlimited funds, it wouldn’t matter quite so much, but rationing in health care is a reality, and only a fool, or a politician, would deny it.
Given that, it makes no sense to allow focus groups or individual patients to drive resource allocation.
At the risk of sounding arrogant, what patients want – especially if they are choosing from alternatives offered by politicians rather than health professionals – isn’t always what they most need.
Finally, the public should start listening to health education messages in 2012. Okay, I accept that there’s about as much chance of this one coming true as there is of Katie Price taking the veil, but it really is beginning to matter.
You will have read the report last month that around 40 per cent of all cancers could be prevented by adopting healthier lifestyles. If you include the obesity epidemic on the list of diseases to which the answer is in our own hands, it becomes clear that a bit of common sense could save so much money for the NHS that we could not only provide all the new drugs and treatments that we currently can’t afford, we’d probably have enough left over to bail out the Greek economy.
It’s not going to happen though, is it? The figures for smoking are incontrovertible (unless you are the CE of British American Tobacco), and yet more than one person in five continues to smoke.
A lot of people reading that 40 per cent figure will counter it with the “My dad smoked for 50 years and it never did him any harm” argument, illustrating yet again the failure to understand risk and risk/benefit analysis which undermines so many health education initiatives.
If we spent more time in school educating children about risk and probability, preferably at the expense of trigonometry, which they will never actually use in real life, the world would be a better and more rational place.
And that would be something to wish for in the New Year, wouldn’t it?