PATIENT CHOICE
Posted: 12 May 2026, 01:35
PATIENT CHOICE
2 January 2006
Before I even start I’ll admit to being angry. The immediate but subsidiary cause of this state is having to listen to Patricia Hewitt lecturing the nation on the subject of ‘we are right and you are wrong’. How one person can achieve such Olympian status in the field of patronising is a subject worthy of a public enquiry, just take it as a given that she enrages me every time I hear her.
The substantive issue which was pontificated on this morning on R4 was ‘Patient Choice’. For those of you who haven’t registered what is happening in the National Health Service here are the bare bones. From the 1st of January 2006 every patient will have the choice of four hospitals if they need to be admitted. Theoretically this is all organised on the biggest single computer system in the world but unfortunately it is not working properly for a variety of reasons, let’s not bother about the technicalities, let’s just agree that it seems to be going the way of the incompetent super systems that are supposed to run tax, child benefits etc. most of which are giving serious trouble and costing billions in consultant’s fees. The system has the additional handicap that the doctors who are supposed to administer it were not properly consulted and many of them refuse or can’t afford to run it.
There is a further problem, the government has decided for political reasons that what people need is ‘choice’. This is the biggest confidence trick since post war credits. People don’t want choice in health and education, what they want are good local hospitals and schools. They would rather see the billions being invested in the super IT system put into providing what they actually want, improved local facilities. They watch stupefying decisions like closing emergency rooms and intensive care beds on the grounds of ‘cost and efficiency’ and are enraged. Can you blame them?
The bottom line is that imposing a vast computer system on an organisation is a centralised matter and can only be done from the top, it is therefore only seen as practical by those whose experience is managing central power, the politicians. The massive and diverse task of managing investment in local facilities can only be done by giving power and responsibility to the local managers and this is anathema to government as they see it then as being outside their control.
One of the best hospitals in the country, the Radcliffe at Oxford has announced this morning that the operation which cured Tony Blair’s heart problem is no longer available to NHS patients. The reason given is that waiting times for this operation exceed the government’s six month time limit on waiting periods, if they allow this to happen they will be penalised financially. It transpires that the basic reason for the bottleneck is that the government has fixed a price of £2,000 for this procedure when the professionals say that the true cost is over £5,000. Never mind the managers or the government, how will the patients feel when they get the letter saying that they will have to pay for the procedure themselves? Can you wonder at the fact that I am angry? I seem to remember a phrase ‘free at the point of delivery’.
On a different subject, but quite fascinating for any student of history, there was another item on R4 about the land register. This is the legal data bank on which all transfers of land ownership have to be registered. It transpires that 50% of the land in England isn’t registered because it has not changed hands during the life of the database. A subsidiary statistic is that 90% of the English population live on or own 10% of the land and this percentage is falling due to concentration in urban sprawls and greater housing density to keep the price of ownership as low as possible.
What amused me about this is the fact that this is the issue which shook the nation in 1910 when Lloyd George had a direct fight with the House of Lords. This is remembered mainly because the eventual effect was to remove the power of the Lords to alter financial bills but the trigger for the original argument was a proposal for a National Land Register. The landed gentry saw this as opening the door to taxation and in the end, erosion of their inherited power. This demand was quietly dropped as it was politic to do so and it fascinates me that in all the talk about reforming the Lords and dire warnings about the effects this would have on the power base of the aristocracy nothing has been said about universal land registration. Could it be that some residual power and influence still resides in the upper echelons of the establishment? Plus ca change, plus c'est la meme chose.
So, when it comes to choice, mark me down as against central control and for the autonomy of local managers in education and health. Mark me as being against new ‘initiatives’, let’s allow health and education to bed down and find a balance. Mark me down for a moratorium on consultants and new super IT systems, let’s get the ones we are saddled with working properly. Mark me down for the imposition of a universal land registry immediately. Right, I think that’s clear. Let’s see if anyone is listening.
2 January 2006
2 January 2006
Before I even start I’ll admit to being angry. The immediate but subsidiary cause of this state is having to listen to Patricia Hewitt lecturing the nation on the subject of ‘we are right and you are wrong’. How one person can achieve such Olympian status in the field of patronising is a subject worthy of a public enquiry, just take it as a given that she enrages me every time I hear her.
The substantive issue which was pontificated on this morning on R4 was ‘Patient Choice’. For those of you who haven’t registered what is happening in the National Health Service here are the bare bones. From the 1st of January 2006 every patient will have the choice of four hospitals if they need to be admitted. Theoretically this is all organised on the biggest single computer system in the world but unfortunately it is not working properly for a variety of reasons, let’s not bother about the technicalities, let’s just agree that it seems to be going the way of the incompetent super systems that are supposed to run tax, child benefits etc. most of which are giving serious trouble and costing billions in consultant’s fees. The system has the additional handicap that the doctors who are supposed to administer it were not properly consulted and many of them refuse or can’t afford to run it.
There is a further problem, the government has decided for political reasons that what people need is ‘choice’. This is the biggest confidence trick since post war credits. People don’t want choice in health and education, what they want are good local hospitals and schools. They would rather see the billions being invested in the super IT system put into providing what they actually want, improved local facilities. They watch stupefying decisions like closing emergency rooms and intensive care beds on the grounds of ‘cost and efficiency’ and are enraged. Can you blame them?
The bottom line is that imposing a vast computer system on an organisation is a centralised matter and can only be done from the top, it is therefore only seen as practical by those whose experience is managing central power, the politicians. The massive and diverse task of managing investment in local facilities can only be done by giving power and responsibility to the local managers and this is anathema to government as they see it then as being outside their control.
One of the best hospitals in the country, the Radcliffe at Oxford has announced this morning that the operation which cured Tony Blair’s heart problem is no longer available to NHS patients. The reason given is that waiting times for this operation exceed the government’s six month time limit on waiting periods, if they allow this to happen they will be penalised financially. It transpires that the basic reason for the bottleneck is that the government has fixed a price of £2,000 for this procedure when the professionals say that the true cost is over £5,000. Never mind the managers or the government, how will the patients feel when they get the letter saying that they will have to pay for the procedure themselves? Can you wonder at the fact that I am angry? I seem to remember a phrase ‘free at the point of delivery’.
On a different subject, but quite fascinating for any student of history, there was another item on R4 about the land register. This is the legal data bank on which all transfers of land ownership have to be registered. It transpires that 50% of the land in England isn’t registered because it has not changed hands during the life of the database. A subsidiary statistic is that 90% of the English population live on or own 10% of the land and this percentage is falling due to concentration in urban sprawls and greater housing density to keep the price of ownership as low as possible.
What amused me about this is the fact that this is the issue which shook the nation in 1910 when Lloyd George had a direct fight with the House of Lords. This is remembered mainly because the eventual effect was to remove the power of the Lords to alter financial bills but the trigger for the original argument was a proposal for a National Land Register. The landed gentry saw this as opening the door to taxation and in the end, erosion of their inherited power. This demand was quietly dropped as it was politic to do so and it fascinates me that in all the talk about reforming the Lords and dire warnings about the effects this would have on the power base of the aristocracy nothing has been said about universal land registration. Could it be that some residual power and influence still resides in the upper echelons of the establishment? Plus ca change, plus c'est la meme chose.
So, when it comes to choice, mark me down as against central control and for the autonomy of local managers in education and health. Mark me as being against new ‘initiatives’, let’s allow health and education to bed down and find a balance. Mark me down for a moratorium on consultants and new super IT systems, let’s get the ones we are saddled with working properly. Mark me down for the imposition of a universal land registry immediately. Right, I think that’s clear. Let’s see if anyone is listening.
2 January 2006