The first post of 2013 comes to you from the cardiac care unit of the QEQM Hospital in Margate. Three days ago I collapsed for the second time in two days; an ambulance was called and a paramedic arrived within 5 minutes, with a full ambulance arriving inside a further five minutes. The NHS at its amazing best. I am well looked after.
This is how the NHS should work; public services provided by the state quickly, efficiently and directly. Yet a couple of weeks previously I had an example of just how the NHS should not operate. I returned from Ghana with a persistent ear infection, resulting in pain, deafness and loss of balance. I went to see the GP who agreed to refer me to a consultant. A few days later, instead of an appointment, I received a letter outlining the NHS “choose and call” programme listing a number of hospitals and phone numbers, and giving me a code to use to book an appointment. This is all in the name of patient choice.
But I really do not want this choice. I want my local hospital – and every local hospital – to have an ENT consultant working to a high standard who can sort out an ear infection. Then I want an appointment to see them quickly. I am not buying a novel or a washing up liquid. The idea that every transaction involving provision of state services should be based on an expensively created and entirely artificial market mechanism is an ideological frippery. Behind that letter lies a mass of administration to record my choice and shuffle invoices and financial transfers between my GP’s practice and whichever hospital I pick. Those invoices and transfers are all entirely internal state administration yet add massively to – multiply – the cost of simply getting a man to look down my ear canal.
There is a parallel here to the private sector distortion by which the middlemen who transfer the money for transactions have contrived ways to complicate that function until they are the major beneficiaries of economic activity.
Thankfully in emergencies this craziness is not yet applied. But I do not rule out one day being stretchered into an ambulance, asked where I want to go and handed a telephone.