You all must be aware of price comparison websites? No? Well, you must be one of the lucky few in the country to have managed to escape their endless ad campaigns. You don't have to be a fan of the meerkats and the operatic idiot in the ads to admit these websites are clever. With a mere click of a mouse they trawl the internet for the best prices out there, whether your desired product is car insurance or a flight to Greece.
So what's my point?
Well, if I were to tell you that in the next 6 months to a year the 'price comparison' model was to be rolled out throughout the NHS, with particular focus on helping health 'consumers' 'choose' the 'best' GP practice in their local area, I think you would be as surprised as I was, initially.
According to my source, significant component of the 'competition' mechanisms that will be part of the NHS 'reforms', will compare 'value' or 'points' in performances of GP Practices. This will start with 1,500 GP practices in London and then will be rolled out throughout the rest of the country.
That's right! When you next have the flu, or a pain that simply won't go away, you'll be able to jump straight on to 'nhs-gp-supermarket.com' to find the right quack for you!
'Come on health consumers!' I'm sure they would counter. 'Get with the Con-Dem programme!' When you're feeling like death warmed up, you'll be able to identify which GP practice in your area is supposedly the 'best'! And even though it's an extra 20 minute-drive away, you'll be so pleased by their 'performance points', that you'll almost enjoy the butterflies in your aching belly, as you exercise your 'right to choose', and go wait in the over-crowded waiting room for your appointment with the 'No1 GP' - best in your 'hood'.
First, let me make the most glaringly obvious point possible: If I want car insurance or a flight to Greece there are companies out there that sell these services at variable prices. I think it's great that a website can search for the cheapest deal for me. But the difference is that GP practices in my local area have never come at a 'price'. Therefore, value will have to be attributed to their services. How are we going to do this? Through the introduction of 'targets' and 'KPIs' (Key Performance Indicators)? Yup, according to my source, that's more likely than not...
This idea, this mentality, this system of attributing points to GP practices, this mimicry of the private sector which puts a price on everything, makes one quake with trepidation for the future of the NHS.
We don't want to have to choose the best practice when we are sick. We're sick, for God sake! We want all the practices to be good, especially the one that is closest to our home, and to be regulated and monitored by those with the right qualifications using the right criteria. Not by some straw poll. The implications of putting a price on everything, is, as the old adage goes, that we value nothing.
But what do I know about being sick anyway? Well, when I was 21 years old I was, very suddenly, taken ill. There was no warning, and when the sickness and pain came, it came with tremendous force and intensity. I was taken to hospital in the back of an ambulance. Test after test revealed nothing. I was frustrated. I lay in a bed in a hospital corridor for a whole night, vomiting violently. A passing surgeon recognised my state and told me I needed immediate surgery or I may die. I was very scared as I was wheeled into surgery. I had to sign a document that said if I died from the anaesthetic the hospital was not culpable. Then I came to. The operation the surgeon performed was called a peritonitis. A cyst attached to my bowel and spleen had perforated, shutting them both down. It was a one-in-a-million chance that it could have happened. But it did happen. It happened to me.
There were times in the months after the operation that I felt shocked and angry. I was angry with the surgeon for not doing a cleaner job in stitching me up. I had stitches crossing back and forth along my belly. I was angry it had happened to me. I was traumatised by the whole ordeal and because of this was angry with all the staff at the hospital and the 'service' generally.
Imagine, if I could at that point, when I was at my lowest ebb, have marked the hospital's performance? What would I have said? If given the options between, 'Very Good', 'Good', 'Poor' or Very Poor' I probably would have said 'Very, Very Poor'!
These men and women, whose names I never knew, saved my life. It was a long time ago and I can see that now, but at the time, I'm not sure that I could.
Patients are not always in the best position to give an objective assessment of the 'service' that has been provided to them. This is why I believe that asking patients to 'rate' performance is fundamentally flawed.
I am also a firm opponent of targets.
When you put a GP, a teacher, a policeman in the position where they have to hit a 'target', surely you are diverting them from carrying out their core function? Surely we are preventing them from actually doing their job.
In David Simon's universally acclaimed, 'The Wire', an embattled police chief who, because his detectives can't close a couple of homicide cases, is passed over for an invitation to a VIP dinner at city hall says, "targets are all that matter now. Nobody cares how we do our jobs anymore as long as we hit our damn targets!" With that, he thumps the table and storms out of the room.
Do we want this mentality further introduced into our public services? I for one, think not.
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