OWEN POLLEY: Patient choice can go too far

WHOEVER becomes the next health minister at Stormont will face serious problems of their own, as they struggle to maintain health services in Northern Ireland against a backdrop of public sector cuts.

But they should also keep a wary eye on their counterpart in London, Andrew Lansley, whose plans to shake up the NHS in England have attracted criticism.

Thanks to devolution, a genuine ‘National’ Health Service is a thing of the past, but changes in England will inevitably influence the way in which healthcare is provided across the rest of the UK.

The government intends to apply its decentralising ethos to the NHS, arguing that it can empower patients and doctors, to the exclusion of managers and bureaucrats.

There is certainly a need to re-examine which health services the public sector should offer and how they can best be delivered to patients. The UK has an ageing population and the NHS consumes an ever greater proportion of the nation’s resources.

Healthcare is a huge priority for the public, but it can’t be allowed to suck up limitless funds, to the detriment of other vital services.

The government’s proposals involve GPs forming consortia, which will be responsible for purchasing drugs and commissioning other treatments. Doctors will have more freedom to take their custom to different hospitals and private providers.

The theory is that competition between hospitals will flourish, driving standards up and keeping costs low. The same concept applies to GP practices, which will compete for patients. Unfortunately, health professionals disagree as to the likely results.

The British Medical Association (BMA), which represents doctors, offers qualified support for some of the government’s ideas, but it is concerned that the changes go too far too fast.

There is also a fierce debate as to whether market principles can be applied effectively to public healthcare.

Whichever way you spin it, choosing a treatment from a hospital is not the same as choosing a product from a shop. If healthcare is just another part of the market, it is one sphere where the customer is not always right. No-one wants a return to the days of overbearing, uncommunicative doctors, but the philosophy of patient choice can be taken too far, particularly when the taxpayer picks up the tab.

A patient led service, where GPs are under pressure to provide the treatments people want, rather than those that they need, has its pitfalls. Thanks to the internet, we already have a whole generation prepared to second guess the advice of doctors, on the basis of their own spurious researches.

The NHS currently has some protection against the pressure of unscientific opinion and popular campaigning. The National Institute of Health and Clinical Excellence (NICE), among other tasks, assesses whether drugs are cost effective or not. Its role as an arbiter could be undermined if consortia are under pressure to provide, for example, costly cancer medication which may add just a few weeks to a terminally ill patient’s life.

There are already treatments and services, like homeopathy or female sterilisation, which the NHS offers against the prevailing wisdom of doctors, simply because the public demands them.

The government must be careful that its policies don’t encourage more waste, when the goal should be to eliminate services whose value is doubtful.

Patients must be properly informed about their healthcare choices, but it’s also important that doctors and the NHS are independent enough to withstand the latest fads and free to exercise their judgement on which treatments are worthwhile.

If people want branded drugs, that are no more effective than cheaper generic versions, expensive non-essential procedures or the latest quack therapies, then they should be required to pay privately, rather than seek out a more obliging GP.

Although the Tory / Lib Dem coalition is often accused of being right wing, the pace of change it is currently setting across government is anything but conservative. Whether it concerns welfare, schools, prisons or local government, there is a desire to drive through reform as quickly and radically as possible.

In many cases the changes are justified, but healthcare deserves the utmost caution. It is by no means certain that the decentralising, market-orientated principles, appropriate to other spheres of government, will produce the best results for the NHS.

Rapid change to the health service is a high-stakes game which, in the worst case scenario, could ruin a prized national institution. Alternatively it has the potential to deliver a system fit to last another 60 years.

In Northern Ireland, where a lack of funds has just cost the NHS its new cancer unit, the experiment in England will be watched with particular interest.

Owen Polley is a political commentator