Criticism
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Criticisms of Government health policy that do not fit the topic pages are included here.
Excessive centralisationThe published criticism is mainly about central targets and controls distorting priorities and inhibiting initiative at local level. More serious is the lack of local democratic accountability. Ministers, whose accountability to Parliament is the only democratic element in NHS governance, easily escape responsibility.
Impact of inequality on healthHealth policy should be about much more than medical services. Issues of the environment and of lifestyle have hitherto affected public health to a greater extent than treatment of people who are already ill. People from deprived areas are likely to die younger and more likely to suffer from the major killer diseases, including coronary heart disease and most cancers. The Good Hospitals Guide includes comparative performance of hospitals. Outside London, where the ancient teching hospitals have always been well resourced and have always attracted patients from long distances, the hospitals with the worst death rates after surgery are the ones in the old industrial areas. It is likely that the biggest single contribution to public health would result from policies designed to reduce inequalities of disposable income. This should have two strands,
The Government has made many statements that it recognises inequality and deprivations as health problems. Is it doing enough? Conversely some Government policies effectively discriminate against people who are deprived, notably the exclusion of people from treatment because they have a lifestyle that is regarded as unhealthy. People have been excluded from treatment because of severe learning difficulties, mental infirmity, excessive drinking, smoking and obesity. Also people who have complained about earlier inadequate treatment have been obstructed when they seek further medical attention. Initiative overloadThere were no significant changes in the management of the NHS between 1947 and 1974. Since then change has become more and more frequent, so that one change cannot have anything like its full effect, let alone be evaluated, before it is displaced by a subsequent change. Government plans in 2005 broadly revert to the management structures before Labour came to office in 1997. Meanwhile the local and regional management has been broken down and gradually recombined, going through at least three recognisable structures. All these changes delay service improvements and incur costs on redundancies and early pensions, higher salaries for managers of new organisations, and design and implementation of new systems. Government should avoid national reorganisations of local and regional management. If there need to be changes at local and regional level, the changes should result form local initiative and by mediated by an independent body like the Local Government Boundary Commission. Government should concentrate on doing well what can only be done at national or international level. For one example that was deliberately neglected (by a budget cutback) in 2005, evidence-based assessments by NICE of new treatments should be made promptly and regularly updated. Only Government can correct inappropriate or out of date relationships between services. Planned changes in the NHS are floated and may be implemented in isolation from changes in the police and fire service. There are strong arguments for combined local emergency control rooms so that the telephone operator who first answers a 999 call immediately despatches an ambulance, fire engine, police car, foot patrol officer, lifeboat etc. This should be possible with technology like Global Positioning System and should eliminate delays from going through a BT operator to an emergency control room for a single service. Such an arrangement may best be operated over a control area similar to those operated by at least one of the existing emergency services, and should in the long term be much more efficient and effective (because of local knowledge) than the single-service control rooms for very wide areas that are currently planned. Such an arrangement would also be of benefit to the user. Government should in general think through the implications of changes in technology, concentrating on provable benefits to the patient. This may lead to more concentration of services needing expensive technology in centres of excellence, but other technology is becoming cheaper and can be moved out to community hospitals and GP surgeries. When Government has to be a party to national agreements, such as on conditions of service for doctors, it can agree to matters that turn out to be mistakes. So within two years of GPs being allowed to opt out of out of hours services the Secretary of State in November 2005 demands that GPs' surgeries be opened for longer hours and at weekends. It would appear that the people who make and advise on decisions at national level have no relevant experience of how services are actually delivered at local level and how they fall short of reasonable expectations. Still less do ministers and senior civil servants have direct experience of the differences between providing health services in conurbations and rural areas. So reorganisations are regularly reversed as a management structure that is designed with a view to one kind of area is found to be difficult to work in another kind of area. Totalitarianism and concealment of issuesAn issue that belongs here is the legislation being introduced in 2003 to encourage the more widespread addition of fluorides into drinking water. Most experts believe that fluorides reduce tooth decay in children. Some experts claim that fluorides are damaging to a minority of people. Some 5 million people have had fluorides added to their drinking water for about 20 years, so before the practice is extended research needs to be done and published showing the correlation between fluoridation and possible effects, both positive and adverse. Since fluorides were first advocated for preventing tooth decay, the market in toothpastes has changed, and most commercially available toothpastes (whether for use by children or adults or elderly people suffering from arthritis) now include fluoride. If fluoride can be damaging, are some people being injured by their toothpastes? If fluoride is added to drinking water, is this double medication with a risk of overdoses? Government decisions to add fluoride to water, commercial decisions to market toothpaste with fluoride, and consumer decisions to use fluoride toothpaste are taken without adequate information on possible adverse effects. See Public Health for relevant articles from October 2003. See also in Need for individual judgment:
Complaints-SourcesSee Harassment of patients for how complainants have been victimised. |