Does the NHS provide health care or is it just a health service? This seems to be a question up for debate at the moment, although it is largely being buried by the news from the wider world and Crewe and Nantwich. The ideas which the government circulated towards the end of last year about healthcare reform are now being formulated into policy, but this has been lost in the melee of the world at the moment.
That the NHS needs reforming is pretty clear, but that getting rid of general hospitals and general practices to replace them with so-called ’super practices’ (or poly clinics) or specialist hospitals is an unsatisfying answer. I have no specialist knowledge or understanding (just a big mouth and a platform from which to shout), but the reforms worry me.
One of the things I think modern (and by that I mean mainly city) living has precipitated is the alienation of certain groups of people. Because there are so many people in one small space it is easy for those who don’t shout loudly or make themselves stand out to get lost. As a teacher I noticed this in schools – in large classes the quiet, diligent students tended to get lost in amongst the more outstanding or needy ones; in large schools the same happens but more students are alienated because of the larger scale. In cities those who don’t make a fuss or stand out can simply fall between the cracks.
What does this have to do with NHS reform? Not a lot really, except that I believe that the strength of NHS lies in not letting people fall through the cracks. Because surgeries are relatively small, patients can build relationships with doctors and feel able to trust them with health and other problems. Doctors are also able to notice any problems and raise concerns with other agencies (ie social services). Changing this devalues the care that is at the heart of the NHS.
So care or service? What do ill people really want – to see a doctor immediately or to see a doctor they trust? Well for most of us I guess both, but for the vulnerable and those in need probably the latter slightly more than the former. I am wary about the advantages of these reforms – as are the BMA, and would like to see a more open debate with more options explored before such a big change is pushed through.
Worried yourself? Sign the petition here.





