21 June 2008

The envy of the world?

By Rupert Read

Should we or should we not give the go-ahead to polyclinics within the NHS? This is the biggest question facing health service policy. It faces us here in Norfolk and Norwich, because there is a proposal to replace the walk-in health centre in Thorpe St Andrew with a city centre polyclinic. That would apparently be a health centre grouping several GP practices with new facilities.

I want to take an indirect approach to the question that I raised, above. I am going to talk about a book which can I think put us in a much better position to maybe answer it.

The book is Alysson Pollock's magisterial NHS plc. The opening lines of its closing chapter, "The emerging health care market", make the stakes starkly evident: "The NHS is being dismantled and privatised. Very soon every part of it will have been 'unbundled' and commodified... a new business dynamic is taking charge of the ways in which services are provided and patients are responded to. The dramatic costs involved - in terms of loss of equal access and universal standards, as well as of money - are concealed by claims of commercial confidentiality."

Our Government's most brilliant achievement of spin has not been its - exposed and now failed - effort to conceal the truth over why it attacked Iraq, but its - largely successful - concealment of the destruction under its tutelage of Labour's greatest ever achievement. It is an act of true political brilliance that the NHS is being dismantled by the Party that created it whilst successfully posing as its saviour.

But, as Pollock predicted, this PR success too is unravelling. The NHS is in serious financial trouble, and for the first time ever, more citizens now trust the Tories (heaven help us!) with the NHS than New Labour. This is the backdrop to the Government’s announcement of the polyclinic initiative.

Now, the NHS was never perfect. Indeed, Pollock herself details how it was perhaps fatally compromised by primary care (i.e. doctors' surgeries) never being nationalised. One could add to that something that Pollock neglects to address: the deep importance of prevention, and how ultimately what we need is not only to defend the NHS, but to transform it into a national wellness service, with a smaller budget for its big hospitals.

But the NHS was incredible value for money; it was the envy of the world in countries from Moscow and Havana to Berlin and Washington. And I've started speaking in the past tense since, for now, the NHS is half-abolished. It is dying; or rather, being killed, because of dogmatic beliefs that private solutions must trump public ones. It is on the way to becoming little more than a kite-mark for numerous outsourced profit-making operations.

If one wants to understand how the NHS has been cherry-picked, cream-skimmed, and bled dry financially by the private sector, at the bidding of the party that once upon a time created it, then there is one thing above all that one needs to do: read Allysson Pollock's book.

And then, I think, a potential answer to our question emerges. Polyclinics could be a very fine thing. Why shouldn'’t people have easy access, in the city centre, to a ser of facilities where they can be treated for a wide variety of ills? Since the Norfolk and Norwich Hospital was so foolishly moved out to the edge of the city, we have lacked anything like this. Polyclinics could be a new form of community hospitals, in effect, but with simple walk-in access.

Just two things: (1) This had better not be at the expense of existing well-functioning facilities, such as that in Thorpe, and such as various good doctor's surgeries around the city. There is a very real worry that polyclinics would in effect compete with existing doctors, and drive them into the ground.

And (2) It had better not be a trojan horse for privatisation. Pollock points out how the Government is trying to engineer more and more private involvement in the NHS. And the big worry about polyclinics is that they will, on the Government's current plans, be open to private companies to run. That is very bad news indeed.

If we are to have polyclinics, then let them be run by the NHS. Not, as could happen under the current proposals, by the likes of Tesco…