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Why the NHS isn’t all about the “N”

Hold up!

See that little date above?

This post was published years ago.

My opinions have changed over time: I think it's quite fun to keep old posts online so that you can see how that has happened. The downside is that there are posts on this site that express views that I now find offensive, or use language in ways I'd never dream of using it today.

I don't believe in airbrushing history, but I do believe that it's important to acknowledge the obvious: some of what I've written in the past has been crap. Some of it was offensive. Some of it was offensively bad. And there's may be some brass among the muck (you can make up your own mind on that).

Some of what I've presented as my own views has been me—wittingly or unwittingly—posturing without having considered all the facts. In a few years, I'll probably think the same about what I'm writing today, and I'm fine with that. Things change. People grow. Society moves forward.

The internet moves on too, which means there might be broken links or embedded content that fails to load. If you're unlucky, that might mean that this post makes no sense at all.

So please consider yourself duly warned: this post is an historical artefact. It's not an exposition of my current views nor a piece of 'content' than necessarily 'works'.

You may now read on... and in most cases, the post you're about to read is considerably shorter than this warning box, so brace for disappointment.

Andy Burnham has written a piece for today’s Guardian announcing that

For Labour, it all comes down to defending the N in NHS … By contrast, the Tories are ambivalent about the role of the centre, preferring localism in health as in other areas.

It’s probably churlish of me to point out that Mr Burnham has previously espoused about the paramount important of locally, rather than natioanlly, influenced healthcare (“The hospital and Primary Care Trust must listen to patients and local people and involve them in shaping the future of the hospital” – hardly a nationalistic approach).

To point him in the direction of the Conservatives’ 45-page Green Paper on the NHS in response to his claim that “on health, Cameron doesn’t do detail” would probably be missing the point.

And let’s just ignore Mr Burnham’s complete lack of insight into the effect of his target-driven culture – Patients being moved like pawns around a hospital-sized game-board to avoid staying in one place for too long – regardless of their clinical need.

Let’s just park all of those thoughts in the vastly overpriced hospital multi-storey, and concentrate on his main point. The ‘N’.

I’m an ardant supporter of the broad principles of the NHS. I think healthcare free at the point of need is a wonderful thing. But I don’t subscribe to Andy Burnham’s ideology of a national health service with national targets to tackle national problems.

The residents of Byker have different healthcare needs to the residents of Mayfair, and the needs of the residents of Tunbridge Wells or Toxteth differ equally again. Whilst it’s true that residents in none of the above places would relish waiting more than four hours in A&E, such meaningless targets do little to disprove the inverse care law which appears to be Burnham’s prime argument for focusing on the ‘N’.

In fact, quite obviously, the most imporant bit is the ‘HS’. The country needs a Health Service that is adaptable to the needs of all. Different locales will, necessarily, have different priorities. Giving Respiratory Medicine the same priority in the North East (where lung disease is relatively common) and in Southern England (where it is rarer) would appear to me to be a failing of a nationalised system, not a benefit.

Targetting outcomes seems eminently more sensible – The respiratory services in the North-East and the South don’t need to be equitable, provided the outcome – measured in cure rate, death rate, or howsoever seems most sensible to the respiratory physicians who are far more intelligent than me – is equitable.

That’s the kind of Health Service I would like. One with an ability to respond to the local health needs of local people – not by “national standards, national pay and national accountability” – all three of which have everything to do with bureauocracy, and nothing to do with healthcare.

This post was filed under: Health, News and Comment, Politics, , , , .




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