- guardian.co.uk, Sunday October 14 2001 04.14 BST
It is ironic that the health editor of The Observer, which has solidly supported the principle of health care provided free at the point of access, should at last have realised the fundamental flaws that underlie the NHS.
I am a life-long Labour Party member and for years an apologist for the NHS. But after more than 25 years practising medicine, like most of my colleagues I have come to believe that the system does not and will never work.
The system conspires to prevent patients making choices about the health care they receive and prevents doctors from providing the health care they know to be right. How can a system, established in the time of Stalin, provide the needs of patients in a world transformed by consumerism? Medicine is the ultimate consumer activity: decisions may affect whether you live or die. How can a civil servant know the needs of everyone, and have the arrogance to think one hat fits all?
The people who work in the NHS are not evil but they are put into an impossible situation where they must lie and compromise on behalf of the politicians of all parties. More money in the current situation is only the good pursuing the bad.
None of the innovations that you suggest, such as published results, patients choosing their doctor or the type of surgery they want or deciding to pay extra for certain procedures, will be possible in our Stalinist gulag.
We need to establish some basic principles:
· no one will be allowed to go without basic health care;
· not all medicine can be free;
· health insurance will be encouraged;
· health statistics to be transparent and available to all.
The basic unit of health care is the doctor-patient relationship. Not a God and subject relationship but one based on trust and honesty in which patients and doctors can make decisions in the best interests of the patient and not of the institution. Health insurance is the only means to achieve this goal. It may mean that the rich pay more but that they may also be able to access parts of the health care system not available to all. For example, one of the commonest operations performed in the NHS is hysterectomy. However, there are many ways of performing the procedure with roughly the same safety but with different costs. It is not a question as to 'which is the best way' in these circumstance but rather 'what are the choices that patients may wish to take'. The analogy with buying a car is simplistic but not far from the truth.
When the patient is paying in this way the relationship between doctor and patient is fundamentally changed in favour of the patient. He or she is no longer a pawn.
We need to begin this discussion in an open and humble fashion and not let warring left- and right-wing factions hijack the debate with 'high' morale principles. The nation's health and dignity is at stake and is more important than the political posturing of vested interests. Let discussion commence.
The author is a senior medical practitioner writing in a personal capacity
