The National Health Service is 60 years old but the latest government reforms in the form of Lord Darzi’s NHS Blueprint leaves it at risk of losing its human face, argues Dr Peter Patel.
Two major anniversaries have been commemorated in the last few weeks.
The first relates to Gordon Brown’s first year in office as Prime Minister, marked by a range of new policy initiatives, not least the Equalities Bill.
The second is perhaps of more importance; the National Health Service was 60 years old on Saturday.
As the Manchester Guardian said on this date in 1948 – “a new system of health centres will soon tackle the scandal of under-doctored areas although against a backdrop of fraught Whitehall negotiations with the GPs”.
How little has changed!
Lord Darzi’s NHS Blueprint, launched on June 30, after lengthy consultation with medical interest bodies such as the British Medical Association, has finally recommended that 150 new polyclinics be established in London and health centres of flexible size be created throughout the remainder of the country, including Birmingham.
The aim of these clinics of various sizes is to tackle health inequalities in our most disadvantaged communities – a goal that has been at the heart of government thinking since the Acheson Inquiry in 1998 pointed up the differences in life expectancy and the divergent incidence of preventable illness between groups characterised mainly by their social class, their neighbourhoods, and their ethnicity.
At a time when we are celebrating six decades of a generally successful NHS, the debate about the so-called ‘Darzi clinics’ centres upon factors that have been central to wider, historic discussions about what the NHS is for, its future as a predominantly public service, and whether health inequalities can be tackled more effectively by policies that tackle deeper economic and social disadvantage.
At an outreach event at Grange Hill Surgery in Kings Norton last month, we kick-started a South Birmingham-led campaign to promote the continuance of community-based delivery of medical services delivered by home-grown GPs.
The “Darzi clinics”, some of which may be set-up and run by private medical companies from across the world, will introduce an unwelcome profit motive into the NHS for the first time, fragment and commercialise service delivery, and reduce the resources available to existing, community-based practices.
Our campaign – which highlights that profit-based health services such as those in the US are usually more costly and less effective in a universal sense (as described by the Wanless Review, commissioned by our current Prime Minister when at the Treasury) – was taken to the House of Commons on July 2.
South Birmingham medical practitioners and patient groups put their case in a well-attended seminar with Perry Barr MP Khalid Mahmood and Lord Tarsem King of West Bromwich offering their support.
There is of course a place for a variety of approaches to tackle the health problems of the most needy areas in a city like Birmingham, which has 137 of its 641 official neighbourhoods in the 10 per cent most health-deprived of 33,000 in England, and where the difference in life expectancy between Sutton Coldfield and the inner city (at eight years) is the same as between the UK and the Philippines.
But we believe that a smaller, more community-based approach is most successful. Grange Hill is a good example of this.
With only a handful of staff, we have met all of the 19 clinical targets set by the NHS, including those concerning heart disease, obesity, diabetes, cancer, and mental health, in an area with a higher than average rate of most of these illnesses.
Small and intimate community-based medical practices achieve this not only through excellence in clinical care but also by providing services to develop a greater sense of well-being among patients. Outreach clinics, complementary medicine, and close involvement of patients all add value to what locally-based medical practices contribute.
Grange Hill Patients Forum member Bob Stevens offers support: “The beauty of a surgery like Grange Hill is the commitment and dedication to families, and taking the time to listen to your problems.”
Another Forum member Gill Craddock said: “It is important to retain the smaller GP practices. In addition to a personal service, the continuity of the patient-doctor relationship is paramount.”
The Government’s proposal to create “Darzi clinics”, especially the larger, less personal polyclinics threatens the comprehensive, high quality and local care offered by family doctors and their staff. We may be witnessing the latest in a series of short-term policy developments that have seen corner shops, post offices, local banks and NHS dentists all close down with little thought for the wider and longer term effects on community cohesion and wellbeing.
If we are really to tackle health inequalities in the most deprived communities in Birmingham, we need a concerted effort in both health and social policy approaches.
Community-based medical services and health education can play a major role.
However, health, well-being and lower life expectancy – mainly in Birmingham’s inner city areas but also in some of our peripheral housing estates – are strongly associated with rundown and overcrowded housing, poor air quality, poverty, low income and low self-esteem, as well as factors linked to certain cultural and religious practices and issues.
Investment in housing, community infrastructure, jobs, skills and education, as well as health, can all play a part in reducing inequalities in health between our most deprived communities and those marked by greater affluence in the suburbs.
The 60-year history of the NHS is replete with continual experiments, evolutions and revolutions in medical practices and science, management and administration.
Dealing with entrenched and vested interests has been part and parcel of change and development since Aneurin Bevin’s universalist dream came into creation in 1948, but should not play too large a role in shaping how future primary care services for the most disadvantaged communities are delivered.
That having been said, at a time when the NHS has grown into a complicated, £105 billion per year services, arguments against the “Darzi clinics” run deeper than that.
We need to preserve the more “human” face of this gigantic service through smaller, family-centred surgeries that place a high premium on being in touch with our patients and the community in which they live.
At the heart of the current debate, then, is the consumerist primary care delivery model, proposed by the Government, versus the long term doctor-patient relationship represented by smaller community-based practices.
We are about listening to local people and working with them to improve their health, well-being and quality of life.
Before we rush headlong into another untested experiment in primary care, can we consider the valuable role that community-focused practices play in deprived communities?