[R-G] [BillTottenWeblog] The Patient Stalkers

[Bill Totten]

Beware of privatisation schemes dressed up as customer choice

by George Monbiot

Published in the Guardian (March 10 2008)


This was surely a victory for the people. We have lost, over the past
twenty years, all kinds of public services, but next month one is due to
expand. After heavy bludgeoning by the government, Britain's general
practitioners have agreed to open their surgeries late into the evening
and on Saturday mornings. As Gordon Brown says, the health service is
"too often centred on the needs of the providers rather than those of
patients" {1}. Now we will have a service better matched to the pattern
of our lives.

This, at any rate, is the government's story, and at first sight it is
plausible. The truth, as always, is stranger and more complex. It begins
with a bare-faced lie.

The government launched its campaign a year ago, with a press release
published by the Department of Health. This claimed that a report by the
Cabinet Office, published the same day, "reveals that nine out of ten"
people polled "said they want public services, such as GP surgeries,
that are open some evenings and weekends, even if that means they would
sometimes be shut during the working week" {2}. This was reported
verbatim by the press {3}, but it was a complete fabrication. I have
read the report {4}. It contains no mention of this poll, or anything
resembling it. The terms "surgeries", "evening", "weekend" and "working
week" do not occur.

But on the strength of this fiction, extended opening hours became
government policy. It is a bit like the war with Iraq: the decision to
go ahead was made before the evidence materialised. Just as the
government was publishing its misleading press release, Ipsos Mori was
completing the huge poll - of 2.6 million people - that the same
department had commissioned. This, surely, would support its fictitious
claim. Who would not welcome longer opening hours?

To the department's intense discomfort, Ipsos Mori found that "the vast
majority of patients (84%) say they are satisfied with the hours their
GP practice was open during the last six months" {5}. Those who must
visit GPs most often are the most relaxed about opening hours: only
among 18-34 year olds - the healthiest section of the population - does
the level of unhappiness rise above twenty per cent {6}, and then only
by a whisker.

But, like the weapons of mass destruction, if the government said the
public demand was there, it had to be. On Thursday Gordon Brown insisted
that "people want weekend opening; people want to be able to see their
GP in the evenings" {7}. Yes, some people do, but not very many.

The Confederation of British Industry was also unhappy with the results.
It commissioned another survey, again from Ipsos Mori. This received
responses from just 1,014 people - one 2,500th of the department's
sample size. It asked a slightly different question: "how easy or
difficult was it to get an appointment at a time that was convenient to
you?". Thirty-one per cent said they had found it "fairly or very
difficult" {8}.

The CBI issued a report claiming that "a commonly heard complaint is
that GP practices are not open at weekends, early in the morning or in
the evening ... GP services are not responding to clear signals for
change from patients" {9}. But it produced no evidence: the survey
didn't ask about opening times. There are plenty of reasons why patients
might have found it difficult to get a convenient appointment.

But even if the government is using dodgy figures and has misjudged
popular support, what's wrong with longer opening hours? Strange to
relate, quite a lot. In some places, where there are large numbers of
commuters who travel far to work, it makes sense. But Gordon Brown wants
to impose it on surgeries everywhere.

This means, in effect, transferring resources from children, the old and
the very sick to working people, who need the services least. GPs will
have to work shifts, which undermines one of the most important
foundations of the NHS: the continuity of care. It is not clear that
longer opening times will in reality be much more convenient for working
patients: the appointment clerks, specialist nurses, consultants,
physiotherapists, dentists, X-ray departments, biochemistry labs, blood
sampling services and computer technicians with whom GPs work are not
available in the evenings and at weekends {10}, so patients might have
to come back to complete the consultation. If the government wants a
genuine health supermarket, open all hours, it will have to pay much,
much more.

So why is it so keen on this reform? Because it assists a quite
different agenda. To avoid the political firestorm big business rains on
any government that stands in its way, Gordon Brown must make constant
concessions. What business wants most is the forty per cent of the
economy controlled by the state. He must find clever and camouflaged
means of delivering it that do not prompt us to take to the streets.

This means waging a public relations war against GPs and the other
public sector dinosaurs who impede choice and change. It means a
thousand small steps towards privatisation. The government is expanding
the number of independent sector treatment centres, even though they
turn out to be far less efficient than the NHS and leave the taxpayer
with major liabilities{11}. It is opening staggeringly expensive
polyclinics, operating seven days a week, which will be run by
multinational companies {12}. It will allow the primary care trust in
Birmingham to shut the city's surgeries and replace them with primary
care units franchised to corporations - the promoter of this scheme
happily admits to modelling it on McDonalds {13}. It is transferring
GPs' surgeries to supermarkets (the first was opened by Sainsbury's last
week) {14} and giving high-street chemists responsibility for diagnosing
and treating minor ailments, even though they are not qualified to tell
the difference between an ordinary cough and lung cancer. No minister
can now discuss the NHS without mentioning "new providers" or
"alternative providers", which is their code for private companies, or
"choice" and "reform", which means privatisation.

The CBI has produced a long list of complaints about GPs' failure to
"rise to the challenge" of the market {15}. In truth they are among the
most efficient workers in the NHS. One of the reasons why their pay has
jumped so quickly is that they have responded more effectively than the
government expected to the incentives in their new contract (giving the
government a further stick with which to beat them). They are way ahead
of the hospitals in their use of information technology. But there is
money in primary care, which is why they are now in the firing line. GPs
say that the government was hoping they would reject its demand for
longer opening hours, knowing that the private sector could then step
into the breach.

None of this serves either the customer or the taxpayer. The irony of
Brown's reforms is that they are wholly centred on the needs of the
providers rather than the patients - as long as the providers are
corporations. So don't wait to take to the streets. Little by little,
the privatisation of the NHS is happening already, disguised as a
crusade for patient power.

www.monbiot.com

References:

1. Gordon Brown, 7th January 2008. Speech on the National Health Service.
http://www.number-10.gov.uk/output/Page14171.asp

2. Department of Health, 19th March 2007. More family doctor services
for deprived areas.
http://www.gnn.gov.uk/environment/fullDetail.asp?ReleaseID=272142&NewsAreaID=2

3. Eg Sarah Hall, 19th March 2007. Fruit, veg and a trip to the GP as
stores are asked to open surgeries. The Guardian.

4. Prime Minister's Strategy Unit, March 2007. Policy review - Building
on progress: Public services.
http://archive.cabinetoffice.gov.uk/policy_review/documents/building_on_progress.pdf

5. Department of Health, 2007. The GP Patient Survey 2006/2007: National
Report, page 58.
http://www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatientsurvey2007/DH_075127

6. ibid, page 60.

7. Gordon Brown, quoted by Daniel Martin, 7th March 2008. GPs grudgingly
agree to work evenings and weekends at last. Daily Mail.

8. LLM Future Services, 2007. Survey conducted for CBI, May 30th-31st
2007. Sent to me by the CBI.

9. Confederation of British Industry, 18th September 2007. Just What the
Patient Ordered: Better GP Services.
http://www.cbi.org.uk/ndbs/press.nsf/0363c1f07c6ca12a8025671c00381cc7/f60cebe0663c98d68025734600573f81/$FILE/CBI%20report%20′Just%20what%20the%20patient%20ordered'%20September%202007.pdf

10. Gruffydd Penrhyn Jones, GP, pers comm.

11. Allyson M Pollock and Sylvia Godden, 23rd February 2008. Independent
sector treatment centres: evidence so far. British Medical Journal, vol
336, pages 421-424. doi:10.1136/bmj.39470.505556.80

12. See British Medical Association, January 2008. Access to GP services
in England. http://www.bma.org.uk/ap.nsf/Content/Gpaccess.

13. Nick Britten, 4th February 2008. GP surgeries 'could be run by Tesco
or Virgin'. Daily Telegraph.

14. Hugh Wilson, 4th March 2008. The Sainsbury's GPs: checkout, then
check-up. The Guardian.

15. See Confederation of British Industry, 18th September 2007, ibid.

Copyright (c) 2006 Monbiot.com

http://www.monbiot.com/archives/2008/03/11/the-patient-stalkers/


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