Derbyshire village wins court battleBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7566.461-a (Published 31 August 2006) Cite this as: BMJ 2006;333:461
All rapid responses
In regard to "Patient Choice" and the response from EDB: Patients
have had choice for quite some time; Private services are widely
advertised. I, however, do not see much evidence for too many voting with
their feet (and wallets) for private primary care providers.
One can compare the uptake for private medicine in Primary and Secondary
sectors, surely the disparity in uptake does provide material evidence
that most people like the system they have for primary care and I suspect
are not going to embrace Plc primary care.
I am sure Ms Hewitt and her colleagues need to take note "socialists" who
embrace the sword of commercialism will politically die either on it or
through the rebellion it will engender. At the end of the day it will be
the consumers who will be the masters, a principal well embodied in the
development of the NHS. At this stage the "masters" have made their
sentiment clear, and this whimper will become a clamour.
Competing interests: No competing interests
The Department of Health’s view, that the Derbyshire case has ‘no
wider implications for the NHS or for Government plans’, is inexplicable.
If this was merely a ‘little local difficulty’, why did the Secretary of
State find it necessary to send a QC to both of the court hearings?
Patricia Hewitt’s QC argued powerfully against the applicability of the
Government’s own legislation to this case, but the Appeal Court judges
found for Pam Smith. The Department of Health should accept this, and
learn as much as it can from the fascinating conversations that took place
about Primary Care and the public. One suspects that the DoH would have
seen the general applicability of the judgement, had the PCT won the case.
It is difficult to see what exactly was in the Government’s mind when
it drafted the legislation about patient involvement, in Section 11 of the
Health and Social Care Act 2001, if it didn’t intend it to be used. This
section, which refers to changes and developments in health services,
states that patients should be involved in
(a) the planning of the provision of those services,
(b) the development and consideration of proposals for changes in the way
those services are provided, and
(c) decisions to be made by that body affecting the operation of those
The Government is in denial that bringing multi-nationals into
primary care represents change for patients. It seems to believe that
general practice is just a bundle of services, and patients don’t have a
right to a view about who should deliver them. Since the Derbyshire
judgement, patients have a legal right to a conversation about this; they
always did have a moral one. There are profound implications in the
proposal to involve multi-national, share-holding companies in primary
care. Do we want ‘chains’ of surgeries, run by executives in London or New
York, and answerable to share-holders? How do we deal with balance of
power? Can we handle the risks of such companies using Practice Based
Commissioning to control the NHS? How do we stop the development of
private monopolies holding us to ransom over our health service?
The village of Langwith recognized that all was not well with the
process that they saw. They held the Government to account over its
rhetoric of a Patient-led NHS, and its legislation on patient involvement.
They delivered an important message that health care is not just about
services, it is also about ownership and solidarity. They did not believe
in the explanation that the private sector was the only option for
‘deprived’ areas; they suspected that they were being used.
The electorate suspects that the Government is privatising the NHS;
the Government, quite genuinely, seems to believe that it isn’t. Leaving
aside issues of sycophancy, competence and integrity, we are now down to
the meaning of the word 'privatisation'; Alice and Humpty-Dumpty had a
conversation about who chooses the meaning of words; Humpty Dumpty’s
conclusion was that it is a matter of ‘who is to be master – that’s all’.
In a democracy, however inconvenient it might seem, this happens to be the
EDB put in a bid for the Langwith practice.
Her bid and some other writing was used in court. Since the bid, she has become a member of Keep Our NHS Public
Competing interests: No competing interests