The health bill has been clothed in such incomprehensible language that it is difficult to see its fundamental flaws – which contribute to a complete lack of democratic accountability.
The first flaw is a misplaced truth. GPs know their patients and what would be best for them – but this is on an individual basis. We are experts in individuals' needs. We have no expertise in population healthcare provision or managing budgets of millions.
The second fallacy: ‘It's cheaper in the community.' Why? Simply because someone, somewhere, at some time, invented the hospital tariff system, which means figures on accounting sheets alter according to where in the NHS a patient receives their treatment.
Moving care only results in an immediate saving to the taxpayer if the overall price of NHS staff or the cost of materials fall. Although this would seem completely obvious to someone stacking the shelves in a shop (the items cost the same wherever you place them), intelligent professionals are sitting in committee rooms enthusiastically stating ‘we could save a lot of money by transferring that into the community'.
While moving care will shorten the hospital waiting lists and undoubtedly provide better car-parking options, only time will tell whether there are any economic savings or health benefits.
Encouragement to move work into primary care leads to the third problem – our conflict of interest. Decisions about who does NHS work will enormously affect our jobs and our salaries. But if we do not participate we will be subjected to centrally imposed diktats.
Closing hospitals
Central control is the bogeyman wheeled out to scare us whenever required. But why not let Westminster take the difficult decisions? We can then continue to act as independent advocates for our patients.
The politicians are being very clever and exploiting our weakness. Our psychological chip? We are GPs, not consultants. The fraternal, never-ending war, fought since medical school. A psychotherapist's dream. ‘We can do it better than them,' we both pipe, blowing our own trumpets so loudly we cannot hear the others. There are some among us who simply cannot resist the temptation to ‘have a go'.
Allowing politicians to hide behind the idea of efficiency savings is the equivalent of counting teabags in Westminster in the hope that you will not have to reduce the number of MPs. Maybe the discussion should be about what the health service should fund. We all agree it should treat sick people free of charge. But what is sickness? Are obesity and hypertension illnesses or risk factors?
Closing hospitals and reducing services are not vote-winning strategies. But we have no mandate to decide these issues. Health rationing needs to be debated openly in Parliament. Politicians have to be brave and state their policies clearly. The electorate will decide whether they like what they do.
The new vocabulary of healthcare – commissioning, consortia, pathways, integration, choice – is the verbal fabric of the emperor's new clothes. There is no democracy at work here, simply the steamrolling of a dubious, non-evidence-based agenda by a small number of market-obsessed zealots.
We are perilously close to allowing them to weave their invisible cloth. They are spinning the public a tale that has no substance, a health policy full of holes. We are the fools if we do not shout out.
Dr Anthony O'Brien is a GP in Silverton, Devon
