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Rapid Responses: Rapid Responses published:
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The Darzi Review
- David Allen (7 July 2008)
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darzi report preventive medicine
- John Pemberton (8 July 2008)
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David Allen, course tutor Manchester University M13 9PT
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The Darzi Review. Yet again politicians are meddling, trying to tell us what sort of health service we are to receive. Including charges, the NHS in England now costs £100bn. That is £2000 pppa is being spent on the NHS. An amount 50% more than we spend on our biggest item of household expenditure, transport and double our expenditure on food and drink.1 Our health expenditure on the NHS is comparable with European countries and yet there has not been a commensurate increase in output, nor are our health outcomes comparable and complaints about the NHS continue. The expected improvements have not been achieved. Now, it is suggested that the NHS needs more money! That would be good money after bad. The NHS is seen by some as the Black Hole of public expenditure gobbling up more and more money, when other items of expenditure such as the Bristol Channel barrage at about £15bn over a ten year build and the high-speed link to Scotland could be funded by a small part of NHS expenditure. How long can the current organisation of the NHS continue? Will the Darzi Report save our “equitable care funded by central taxation and free at the point of need” NHS 2. I do not think so. The government claim that they are setting no more targets in the NHS, but most managers who are told that quality is a priority would see that as a directive and it becomes another target. There are too many different services providing for a very large variety of needs for politicians to decide what the best health service for patients is. The NHS is a "politically controlled state monopoly that is inefficient, outdated, and unsustainable,"3 with shades of British Telecom in the 1970s: a poor, limited and expensive service, which we had to take since we had no other choice, unable to increase efficiency and respond to the needs of customers. If the NHS is to continue to be tax funded, then politicians have to be involved, but patients’ influence can be increased and politician’s involvement reduced. If those responsible for commissioning care, the PCTs, were allowed to compete for patients and patients could choose from a selction of PCTs the package of care they preferred, then there would be incentives for PCTs to look for more efficient ways of using resources and provide services that are more sensitive to the needs of patients 4, 5. Politicians would retain only decisions about the levels of capitations and possibly, what minimum audited data set of information the PCTs should provide to enable patients to decide which PCT should be responsible for spending their capitation allocation. Then the NHS could continue to provide equitable care, funded by taxation and free at the point of need and patients would get the service they want and deserve. References 1 Ed Dunn Family Spending, 2007, Office for National Statistics http://www.statistics.gov.uk/downloads/theme_social/Family_Spending_2006- 07/FamilySpending2007_web.pdf 2 Fiona Godlee, (2008) Editor’s Choice: The NHS in our hands. BMJ 2008;337:a663 3 Luke Johnson in Rebecca Coombes, 2008, NHS Anniversary The NHS debate, doi:10.1136/bmj.a628, BMJ 2008;337:a628 4 David Allen (2007) A Rational Way Forward for the NHS: bmj.com, 15 May 2007 http://bmj.bmjjournals.com/cgi/content/full/334/7601/969?ck=nck 5 David Allen (2007) Re: What lessons are there for the UK and the NHS from Professor Reinhardt article? bmj.com, www.bmj.com/cgi/content/extract/334/7599/881 Competing interests: None declared |
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John Pemberton, retired iona cannonfields hathersage hope valley s321agdarzi report
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It is amazing that so llittle mention is made of preventive medicine in the Darzi report. A very important part of the GPs work consists of health education and giving inoculations. The former,for example, has helped to achieve the remarkable reduction in lung cancer deaths and the great reduction in infantileand child mortalkity. Deaths from many infectious diseases have been greatly reduced, or even eliiminated, as in the case of poliomyelitis, by inoculations. In all these programs, and in daily advice on health matters.the general practitioners have played a great part. This role should be widely recognised and the GPs encouraged and helped to do even more preventive work. Competing interests: None declared |
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