NHS reforms: How to make health services truly market driven

There seems to be an impasse of conflicting opinions on the NHS Reforms.  However, the NHS could be reformed to provide a high standard of care in a very efficient way and in a manner that would satisfy all political parties and professions.  This could be based on the assertion made already that patients will be able to participate in all decisions about their care – “no decision about me without me”.

Targets tend to distort markets and economies, often leading to waste and inefficiency.  The old Soviet Union’s targets and its fate showed on a grand scale what can go wrong.  We see something similar happening now when patients’ needs are ignored and resources wasted in order to meet targets and deadlines.  The worry is that another market distortion, this time based on imposing competition rules designed to drive down costs and not based primarily on patient need may result in false economies and increased costs in the long run.

A true market is based on delivering what the client needs, accompanied by a contract.  This is often described as ‘providing what is written on the tin’.  Not everyone can tell if they are being cheated but as long as some can, the deliverer will have to take care to make sure that what is provided to everyone is according to the contract.  This is what happens in successful markets at present.

In health, the contract should be a transparent written summary of what has been agreed (and consented) between patient and doctor.  This could be on paper or stored electronically to be produced on demand.  It would be made ‘transparent’ by linking each action explicitly to the diagnosis and to the findings that prompted that action and that are being used to assess its outcome.  A high proportion of patients (or their parents, children, grandchildren, nieces, etc) would be able to read and understand it, so the care and how it is summarised transparently would have to be of a high standard for everyone.

All that this needs is an educational programme that uses existing systems that are already in place and fully funded.  The transparent written summary can be produced with current IT systems.  The educational methods are also available already.