The answer is, if the crisis is acute, yes very well. This positive answer to a simple question becomes a lot less positive the more routine the diagnosis or treatment required. This is not because people are incompetent. It is because they are being asked to run an infinitely variable facility within the strictures of a rigidly programmed service. I will give your a personal example.
I suffer a heart condition of several decades duration. It has to be managed, but is not, in itself dangerous, if treated. Recently it started playing up, due to a clash of pills. It took me a week to get an appointment with my own GP (rather than the duty doctor). We agreed a revue by a consultant would be a good idea, the last was some years ago, as well as some tests to check the current status of the cardio-vascular system. I saw the GP on April 12th. The nearest consultant appointment at the local general hospital is July 1st. That is nearly three months.
I asked my GP if he favoured the controversial reforms. ‘Rather’ he said enthusiastically ‘then we would be able to do all these tests here at our own medical centre within a day or two and the consultant would see you here.’ Whether his hopes will be realised remains to be seen. What was clear in that short conversation, is that for most run-of-the-mill treatments the local surgery or medical centre is not only the most convenient place to provide it, it is also the most cost effective.
About forty years ago the emphasis of health-care shifted from the patient’s doctor, to hospitals, who organised consultations for even quite basic conditions through clinics run by a consultant, assisted by trainees. The same hospitals and medics also have to provide all the acute care associated with emergencies and hospitalisation. This is illogical, inefficient, expensive and patient unfriendly. It is not what hospitals are for. This is why there must be reforms. We are running a dysfunctional system which makes patients suffer for long periods and consumes both human and financial resources, in complete disproportion to its outcome.
The biggest flaw is its culture of waiting. What other service, business, or public function thrives on waiting for late appointments, delayed treatments and routine tests? The answer is none. One of the reasons that health-care professionals become so agitated about the proposed reforms, which they fear are privatisation by the back door, is that they know that in a free and competitive medical world, patients would no longer be willing, meekly and uncomplaining, to stand in line.
Instead of consulting, the government should have backed Lansley. It is now promising so many u turns, it is almost spinning on its axis. The most vocal doctors, who are themselves the greatest barrier to a proper health service in this country, smell victory. If they get it, the sick and the vulnerable and the taxpayers will be the losers. The government should have stuck to its guns.
It should call the bluff of these doctors by making one very big reform. ALL NHS doctors should be employed by the NHS and work exclusively for it. Those who want to practice private medicine should do separately and pay back to the state, the cost of their free medical training. Not only do these people block progress, they also make a fortune on the side with private patients culled from their NHS waiting lists. The GPs are not employed by the NHS, any of them. They are under such a barmy self-employed contact, that they are among the highest earners in the community, whilst refusing to look after their patients after business hours. No organisation operating to this business model can deliver a cost effective outcome for taxpayers, nor timely health-care for patients.
If the government bottles out of this opportunity to set things right, it will do itself no credit. It will also guarantee that at some point in the future the NHS, in many ways a state within a state, will, like the banking economy of so recent pain, collapse. Whatever government is in office when that happens, will find itself out of office for at least a generation.