Danger to public health

The UK government's plans for "bottom-up" reform of the National Health Service have run into fierce opposition from, well, just about everyone. The plan, which was nowhere to be found in either the Tories' or LibDems' election pledges, involves giving control of 80% of the NHS budget to local groups of GPs, replacing the existing faceless "primary care trusts". The doctors' own professional bodies have come out against it; nursing organisations are up in arms because there's no role for them; patients' groups are terrified of what looks like a leap in the dark; and even the media, some of whom were initially enthused about the increased role for private sector providers, are frantically rowing back.

In response, the Health Secretary Andrew Lansley has announced a period of fresh consultation, or as he puts it "pause, listen and engage". (It sounds like he may spend his weekends refereeing rugby matches, but that's just speculation on my part). However, it's not clear whether this will result in any real changes to the legislation, which is still expected to be brought forward in June. A BBC reporter on the story today insisted that there will be no change in the "direction of travel", which is one of those phrases that normally causes me to need medical attention.

What's the biggest waste of money in the NHS today? No, actually, I don't know that either, but one candidate has to be overprescribing of medication by GPs. A frequently-cited example, not least by doctors themselves, is the provision of antibiotics to cold sufferers. This is a perfectly ineffective treatment, but it's often the only way to get the patient out of the consulting room without a tantrum.

The government's proposed reforms are supposed to align health care spending more closely with "patient needs", but as this example demonstrates, GPs often find themselves catering to patient wants rather than needs, even when the distinction between the two is perfectly clear from a clinical viewpoint. There's every reason to fear that the same would happen if GPs are given control of more of the health budget: those who shout loudest will get the treatments they want, whether or not that produces the best results from a societal viewpoint.

We already know what happens if healthcare is based on patient wants rather than needs, because that's what happens in the US. Healthcare swallows up 15% of the largest GDP in the world, yet tens of millions of people have no health cover, and outcomes, as measured by life expectancies, are no better than in other countries that spend far less.

Nobody could claim that the NHS is perfect. In a lot of respects, it's not very good at all. However, the UK's extensive private system provides a useful yardstick for the performance of the NHS. In that context, the loss of revenues suffered by private health care providers over the past decade suggests that increased spending has produced positive results in the public system. If Andrew Lansley really does intend to "listen", he will hear health professionals telling him that his "direction of travel" is all wrong.