Socialist Health Association Wales

Wales

Socialist Health Association Wales

Minutes of the AGM, SHA Cymru Wales  2013

Contact Prof Tony Beddow ToneSue@aol.com

Prof Tony Beddow

Prof Tony Beddow

CITIZENS’ VOICES OR CONSUMERS’ CHOICES?

In Wales, we still take pride in community. Our patients, our nurses, our doctors, our hospitals; before the NHS that’s how Welsh health services grew, and how we still think of them. Because science is always advancing, we’re always learning to care more and better for people with growing expectations, so our NHS can never stay still, but neither our NHS staff nor our hospitals want or need competition to make them work harder or faster. Consumer choice won’t create more staff or hospitals, our main problems after many years of under-funding. We have no surplus, so choice between competing providers can only mean that one patient’s gain is at the expense of another.

Health care is not a commodity like clothes or holidays, for which consumer choice is appropriate. Its efficiency and effectiveness depend on co-operation between citizens and staff, flexibility and understanding that there is nearly always somebody else worse off than we are, and that staff can’t do more than their best. In return for that understanding, we expect staff truly to do their best. Though we’re rarely disappointed, we need to develop much more community participation in policy and day-to-day running of NHS Wales, with more constructive criticism from users, and less destructive criticism from news media.

How to do this, in reality not just words, depends mainly on studying local best experience, and then applying that experience everywhere. So far, less than 1% of people qualified to elect representatives to Boards of English Foundation Hospitals have used their vote; power has moved from central government not to the people, but to local bureaucrats hand in glove with corporate business. In Wales we want every level of NHS care to have local representatives elected by users in the communities they serve, but as well as this formal democracy we need to encourage beginnings already made by voluntary bodies created by people with specific problems who are high users of the NHS, giving them a voice in development of the services they use. From these beginnings, which already exist, we might develop more participative citizens with their own intimate knowledge of health problems. We need to understand how intimidated most people still are by doctors and other experts. These more specialised voluntary bodies need help from the Assembly to make them better known and meet some of their administration costs, perhaps through the UK Expert Patients Programme, which is already centrally funded.

We need citizens’ voices not consumer choices, but health care can’t be delivered in standard packages, it must reflect the very different needs of individual patients, and of course this entails choice. This is not new. We have always known that care is more effective and efficient when given by staff who know their patients well through continuing responsibility and shared local records, so they can adapt care to personal needs. The time of a mother with three young children is just as scarce and important as the time of specialists, and referral arrangements should reflect this. Patients should have real choices between terminal care at home or in hospital, which means more funding for home care and hospice support, not just for cancer, but all terminal illness. We have always defended the right of patients to choose their own GP. More flexibility is needed to provide some choice between specialists when relationships break down, particularly in psychiatry, but just as choices between GPs can be made within primary care teams, choices could be made between specialists within hospitals. Much more needs to be done to resist fragmentation and division of services which disrupt this continuity, and shopping around between doctors and hospitals rated by league tables won’t help.

We also need, and are already getting, an increasing choice between new kinds of specialist care both by doctors and nurses. A few rare or extremely difficult problems may need to be concentrated at single centres serving the whole of Wales, with a monopoly of care, because that is the only way to ensure that ultraspecialist staff get enough ultraspecialised experience, but for most problems wider choices can be developed economically within easy reach for visiting by family and friends. A wider range of specialist skills and opportunities for advanced training within each primary care team and each District Hospital, so that each has a full range of specialist staff appropriate to those levels of care, could be achieved by investment in those units working in co-operation, not as business trusts competing for patients.

Shopping around for care among competing providers is not the answer to our problems, it would make them worse. The Assembly has roughly doubled intake of medical students and nurses for university courses, but this will take about 10 years to produce new staff actually working. There is no quick solution. When eventually we get these new staff, we shall need them to work for the NHS, not for private companies recruiting staff trained by the NHS to do the easiest parts of care for profit. The NHS in Wales will remain what most Welsh people have always wanted and still want – our own doctors, nurses and hospitals, all doing their best in a public service planned to meet health needs, not profit.