You won’t often hear many good things coming from a socialist about the current healthcare market reforms – but I think people need to be made aware of at least one potential benefit.
NHS accounts are currently based on analyses of single variables, e.g. the number of people with cardiac problems in a given area, or the number of people with a mental health problem. The government tends to demand action on one of these targets, e.g. the mortality rate for a certain hospital. The problem is that these performance indicators are never integrated. That means that you as a consumer can appear on any number of these single variables; but no-one ever thinks about what life is really like for you in terms of how all these variables operate with/against each other.
The first job that GP commissioners should do is look at what the big retailers do in order to understand their consumers. They should add together all the data they have on people and come up with profiles for ‘typical’ groups of consumers. With this method they can begin to understand people’s lifestyles, homes and workplaces. This is important because these are the main social and economic determinants of health. Without this knowledge GPs cannot start the most important public health task of preventing people from becoming ill, or intervening early if or when they do.
The next step for GP commissioners, is to look at the health status of these different groups of consumers. Which group has a higher rate of coronary heart disease? How might depression be represented differently within the different lifestyle groups? What are the main health and social care narratives from each consumer group? What groups have the worst patient experiences? Armed with this new knowledge they can start talking to the big retailers and public servants, and using the same language, they can discuss how to influence poor lifestyle choices that cost us millions of lives and money.
If GPs were to accept this style of commissioning we needn’t sell off the NHS hospitals, or close down services for minority groups; rather we can work with the private sector, to reach out to the needs of individual consumers within their changing sociological landscapes. After all this is the role of public services within a global capitalist system. Furthermore, it would go some way to deliver a more integrated public services so that taxpayers can see more easily how their contributions become entitlements. In the end….This is not just care, this is NHS ‘Whole Person Care’.