
Socialist Health Association Wales
Socialist Health Association Wales
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.
- Realistic hope for a Social Care system driven by Human Rights from Scotland February 19, 2021
- Social Market Stability in Wales — Consultation Response SHA-Cymru February 3, 2021
- A WELSH BENEFITS SYSTEM MAKES SENSE January 25, 2021
- EDUCATION AND COVID ADVICE == WALES November 15, 2020
- SHA Cymru statement in support of the First Minister and Welsh Government November 6, 2020
- ASSESSING THE VIABILITY OF THE SOCIAL CARE SECTOR — Response to Welsh Government Proposals October 7, 2020
- WALES — HOW SUSTAINABLE IS OUR CARE SERVICE ?? September 24, 2020
- A Scalpel or a Butcher’s Knife to our Public Services —- and to the UK? August 25, 2020
- TEST, TRACE AND PROTECT IN WALES; A PUBLIC SERVICE RESPONSE TO COVID-19 July 21, 2020
- SHA Cymru Wales: Response to Welsh Labour’s Stage Two Consultation paper on health and social care. June 17, 2020
- Blanket DNACPRs are not the solution for panicked healthcare rationing May 12, 2020
- WELSH GOVERNMENT PROVIDES ADDITIONAL £500 PAYMENT FOR SOCIAL CARE WORKFORCE May 1, 2020
- WELSH STEPS TO EASE COVID-19 PUBLIC HEALTH MEASURES – UPDATE April 24, 2020
- THREE WEEKS FOR REFLECTION – COVID 19 WALES April 18, 2020
- A HEALTHIER WALES — GOOD PROGRESS BUT GREATER URGENCY NEEDED January 6, 2020
- REMEMBERING DR JULIAN TUDOR HART. July 4, 2019
- WELSH GOVERNMENT ANNOUNCES INCREASED GP TRAINING PLACES June 25, 2019
- WELSH GOVERNMENT INVESTMENT IN GENERAL PRACTICE June 25, 2019
- PUTTING THE BEVAN PRINCIPLE IN PLACE .. March 6, 2019
- JULIAN TUDOR HART — A TRIBUTE BY PROFESSOR GRAHAM WATT. February 12, 2019
- Caring for an ageing population – some Welsh perspectives January 27, 2019
- ‘LEGISLATION WATCH WALES’ – October 2018 October 18, 2018
- A Healthier Wales? Cymru Iachach? August 30, 2018
- SOCIAL CARE PRIORITIES & OPTIONS IN WALES May 26, 2018
- Letter in response to news item on oral health May 17, 2018
- PLANNING IN THE WELSH NHS April 16, 2018
- HYPOTHECATION — MAGIC BULLET, PLACEBO OR SOMETHING WORSE? April 2, 2018
- Will Parliamentary Review Deliver Major Change in Wales? March 18, 2018
- WELSH HEALTH AND SOCIAL CARE – PARLIAMENTARY REVIEW INTERIM REPORT October 11, 2017
- Legislation Watch Wales June 28, 2017
- NHS in Wales escaped the cyber attack May 16, 2017
- First Ten Years of Free Prescriptions in Wales April 20, 2017
- PRIMARY CARE NETWORKS IN WALES March 12, 2017
- REVISED GENERAL PRACTICE CONTRACT IN WALES March 6, 2017
- PARLIAMENTARY REVIEW FOR HEALTH AND SOCIAL CARE IN WALES — WILL IT BE A RUSHED JOB? February 27, 2017
- ‘LEGISLATION WATCH WALES’ – February 2017 February 19, 2017
- Deemed Consent for Organ Donation – one year on in Wales. December 1, 2016
- The Question of Structure September 17, 2016
- Wales in prudent health June 8, 2016
- What is on Offer for Health and Social Care in the Welsh Assembly Elections? April 26, 2016
- OECD & WELSH NHS — IMPROVING BUT NEEDS TO IMPROVE LIKE REST OF UK NHS March 29, 2016
- Legislation Watch Wales March 19, 2016
- NHS in Wales February 25, 2016
- SOCIAL CARE REVIEW IN SCOTLAND January 15, 2016
- SOCIAL WORK IN WALES VALUED January 14, 2016
- TACKLING INEQUALITY — CAN YOU FOLLOW THE MONEY? December 7, 2015
- Our health our health services October 20, 2015
- Congratulations October 18, 2015
- TTIP petition handed in to Geraint Davies MP October 10, 2015
- NHS funding: record-breaking cuts? October 6, 2015
- Legislation Watch Wales August 22, 2015
- Referred pain in the care system July 9, 2015
- Legislation Watch – Wales March 15, 2015
- Rural areas count the cost of broken political promises March 6, 2015
- NHS Wales February 15, 2015
- WHAT DO THE WELSH THINK OF THEIR NHS February 5, 2015
- Funding of Welsh NHS January 8, 2015
- Welsh Legislation Watch November 17, 2014
- Cancer Treatment Fund for Wales? November 6, 2014
- PRUDENT CHOICES FOR A PRUDENT WELSH NHS November 5, 2014
- Having a baby in Wales October 26, 2014
- Daily Mail claims on Welsh NHS October 24, 2014
- DAILY MAIL STILL GOOSE STEPPING ON THE TRUTH ABOUT WELSH NHS October 23, 2014
- Bill to ensure safe nurse staffing levels in NHS Wales September 16, 2014
- Notes of SHA Cymru Wales Officers Meeting June 26, 2014
- Notes of SHA Cymru Wales Officers Meeting June 12, 2014
- Andrews Report — A failure of trust May 29, 2014
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- Welsh NHS : Cameron and Hunt – Apologise to the House and to Wales April 15, 2014
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- Legislation Watch – Wales March 6, 2014
- The NHS in Wales March 3, 2014
- Wales Cancer Patient Experience Survey January 31, 2014
- Williams Commission Report On Public Services in Wales January 26, 2014
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- Minutes of the AGM, SHA Cymru Wales 2013 December 16, 2013
- Notes of SHA Cymru Wales Officers September 29, 2013
- Hilda Smith MBE April 13, 2013
- News from Wales March 2013 March 23, 2013
- A New Kind of Doctor 10 A New Social Alliance October 23, 1988
- A New Kind of Doctor 9 The Necessity Of Community October 23, 1988
- A New Kind of Doctor 8 Accountability For And To Groups October 17, 1988
- A New Kind of Doctor 6 A CRISIS OF ACCOUNTABILITY October 17, 1988
- A New Kind of Doctor 7 Accountability For and To Individuals October 16, 1988
- A New Kind of Doctor 5 Measurement of Omission October 15, 1988
- A New Kind of Doctor 4 New Ideas in Old Structures October 14, 1988
- A New Kind of Doctor 1 Points of Departure October 9, 1988
- A New Kind of Doctor Foreword October 9, 1988
Welsh Government – Test-Trace-Protect
- Bevan Foundation
- Changes to the English NHS
- Clear Red Water Rhodhri Morgan 2002
- Free Prescriptions: A Welsh Solution To Welsh Health Problems 2007
- Health in Wales
- History is what you live: Health and regeneration in Wales
- Nye Bevan Lecture 2004
- Organising for Health: The Design of a New NHS for Wales
- Plaid Cymru health policy
- Targeting Poor Health in Wales -Townsend Report
- The Miner’s Canary, let it fly Inaugural Professorial Lecture given by Tony Beddow
- Welsh Policy Forum Consultation Document December 2004
- Welsh Policy Forum Consultation Document Health and Social Care October 2006
- Welsh Health and Social Care Committee
Minutes of the AGM, SHA Cymru Wales 2013
Contact Prof Tony Beddow ToneSue@aol.com
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