Gordon Brown has a fascinating plan for the NHS: Increase patient choice, whilst simultaneously driving the cost of healthcare down to deliver better ‘value for money’. The plan is fascinating primarily because its two aims are utterly contradictory.

As any good economist – Gordon Brown included – will tell you, the greatest economies are those of scale. If the more specialist services from seven Anytown General Hospitals can be lumped together at the Bigcity Regional Specialist Unit, and the five GP practices in each Anytown are combined with the remaining General Hospital Services in a Polyclinic, then costs can be massively reduced. Less real estate, fewer administrative staff, and fewer healthcare staff are needed to serve the same number of patients. Economically speaking, it’s a nobrainer.

Yet while the out-of-town model is great for businesses and retailers, it’s crap for healthcare – and also flies in the face of current policy. Which is where Mrs Goggins comes in.

Gordon currently wants to offer old Mrs Goggins a choice of places to have her cataracts seen to – most likely, she’ll choose Anytown General, as it’s closest to her house and more convenient all round. She’s unlikely to be attracted by the lure of Bigcity Regional Specialist Unit, 50 miles away, and she’d rather wait an extra couple of months to have her eyes operated on closer to home. And that’s pretty much all well and good.

In a few years’ time, however, Mrs Goggins won’t have that choice. She won’t be able to go and see her local GP any more, she’ll have to travel all the way to the Health Village on the old Anytown General site, where she’ll be assessed by an economically friendly Nurse Practitioner, who will then refer her over to Virgin Healthcare’s Bigcity Regional Specialist Unit, where she can go and be assessed by another Specialist Nurse Practitioner who can consider whether or not she need make the 50 mile round trip again another day to actually see the consultant, and then a third trip to have the operation done…

When she gets to the Virgin Healthcare Bigcity Regional Specialist Unit, she’ll find she’s on a very noisy, open eight-bedded bay… but this is Virgin, so fear not, she can pay £15 per night to upgrade herself to her own private side-room with her very own TV. She won’t be able to afford to heat her house for the next few weeks, but it’ll be worth it to make her comfortable in hospital.

Her follow-up is, of course, based at the Hospital – disparate community follow-up services are desperately financially wasteful – so she can treat herself to a few more 100-mile round trips before even contemplating having the second eye done.

Of course, Mrs Goggins will still have some choice – she needn’t go to Bigcity if she doesn’t want to – she can go to any of the Specialist Units in the country, she’s not restricted to the nearest.

Or else, she could decide that the whole thing is far too hard, and she’ll just put up with her cataracts – And, after all, that’s the best choice for us, economically speaking.

» Image Credit: Original photograph by Christopher Walker, modified under licence.