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EDITORIALS: Gwyn Bevan Is choice working for patients in the English NHS? BMJ 2008; 337: a935 [Full text]

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Choose and Book fails to deliver choice

Henry W W Potts   (8 August 2008)

Redisorganisations cannot hide a failing service

Peter G Davies   (18 August 2008)

Choose and Book fails to deliver choice 8 August 2008
Henry W W Potts, Lecturer University College London, London N19 5LW Send response to journal: Re: Choose and Book fails to deliver choice	Bevan's editorial rightly highlights underlying issues with the consumerist model of patient choice. In a study published this week on Choose and Book, Does Choose & Book fail to deliver the expected choice to patients?, we found that patients were not experiencing the degree of choice expected. This, I suggest, partly reflects that the system does not offer patients real choices that matter to them. If patients going through Choose and Book are not experiencing choice, the mechanism by which patient choice is meant to improve hospital performance through competition will not work, undermining the logic of these reforms. Competing interests: None declared
Redisorganisations cannot hide a failing service 18 August 2008
Peter G Davies, GP Principal Keighley Road Surgery, Illingworth, Halifax. HX2 9LL Send response to journal: Re: Redisorganisations cannot hide a failing service	The NHS is now a failing service. It has the long term future of British Leyland. The very fact of the large number of reviews (1) and changes of policy tell us that there is no coherent strategy that makes the NHS work. The number of changes of secretaries of state and chief executives (at central and local levels) mean that the NHS shows the characteristic of a failing organisation- namely that no matter who runs it or what it does the organisation does not work. To the patient this shows up as disorganisation, poor hygiene, poor communication between health sectors, and errors of omission and commission. To doctors this shows up as the everyday frustrations and inefficiencies that make working in the NHS so unnecessarily stressful. It is currently being suggested that doctors should be enthused by “clinical engagement.” But as a practising, and hopefully competent, doctor, why would I want to be involved with whatever the next great policy to go will be? And why, as part of “an organisation with a memory” should I not just recall past redisorganisations and wait for the next one? Indeed as a doctor I can propose the “Spaceship Experiment.” If we sent all the DH policies, and their authors and their management implementers from the last 20 years into space would we feel any need to bring many of them back? Indeed like Diogenes the Cynic, may I suggest that the best thing the NHS could do for doctors and patients would be to get out of our light? Currently the NHS does not provide a good venue for bringing doctors and patients together effectively. (2) When the NHS starts to focus on how to get doctors and patients to work well together (3), rather than on management initiatives of doubtful provenance and relevance, then it may become a successful medical system. 1. Gwyn Bevan Is choice working for patients in the English NHS? BMJ 2008;337:a935 (Published 8 August 2008) 2.Davies, P. (2006) The Beleaguered Consultation British Journal of General Practice. March 2006 56:226-229 3.Tudor-Hart, J.T. (1988) A new kind of doctor Merlin Press, London Competing interests: NHS GP trying to provide a good service to patients despite government and PCT distractions.