I thought you might be interested in this input to Labour’s ‘Big Conversation’

I am writing in order to respond to Chapter 4 of The Big Conversation. I work in public health and am therefore very familiar with the issues this chapter addresses.

As an experienced researcher it is evident to me from the way the questions are phrased that this is not a genuinely open consultation: rather, the formulation of the questions gives a strong impression that a particular kind of answer is being sought. For example, a question like ‘How can we continue to expand choice within the NHS in ways that are consistent with its core values?’ Implies that the expansion of choice is self-evidently a good thing. In fact, the concept of ‘choice’ as it is currently being employed in government health policy is arguably an inappropriate concept – and one which is likely to widen existing health inequalities. While Labour and NHS values imply that people should be able to choose comprehensive, local health services, all of which are free at the time of use, the current notion of choice does not necessarily promote this. In many cases it promotes the notion of patients having to travel long distances in order to access care more quickly – clearly this favours better off patients whose carers, relatives and friends can also afford to travel to visit them while they are being treated. In reality, it favours no-one at all, other than the distant providers of care. In addition, since there is no parallel expansion of local support services in the community, poorer patients are once again likely to suffer due to reduced access to follow-up care.

What is actually required to improve the NHS is for the excellent principles of clinical governance introduced by New Labour to be universally applied, in conjunction with new NHS investment, to ensure that everyone has access to comprehensive local quality NHS-managed and provided services (including dental services). Evidence also suggests that in primary care, these services should consist of extended primary care teams working from NHS health centres.

It also needs to be acknowledged that all NHS charges contradict the founding principles of the health service, in particular that of equity. Thus all dental, optical and prescription charges should be phased out and ultimately abolished.

If Labour were to adopt the goals outlined above this would prove infinitely more popular with the electorate than the application of inappropriate concepts of consumer choice within health and other welfare services.

These are hardly radical or socialist prescriptions – nor are they reactionary or naive. They simply represent well-established social democratic principles of welfare of which New Labour should be proud. The current neo-conservative flirtation with business and market models of health care is wholly at variance with the good work which New Labour has carried out in areas such as clinical governance. We must get back on track before the NHS is irreparably damaged.

Alex Scott-Samuel

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