Radical proposals for revamping the capital’s health services intended to meet the needs of Londoners, include far more than the widely-reported intention to move the majority of care from old-style general hospitals to polyclinics and urgent care centres closer to people’s homes. Few would argue with the need for more and better services provided through community-based facilities designed to overcome inequality, complemented by an integrated network of specialist hospitals.
But deep in the report, and destined to disappear, are links with the Mayor’s Health Inequalities Strategy and acknowledgement of the long-forgotten Wanless reviews carried out in 2002, 2003, and 2004 which concluded that the "fully engaged scenario’" was the cheapest option and delivered the best health outcomes. In this scenario, the level of public engagement in relation to health is high, life expectancy goes beyond current forecasts, health status improves dramatically, use of resources is more efficient and the health service is responsive with high rates of technology uptake.
Professor Sir Aru Darzi, author of the new report, commissioned by London’s Strategic Health Authority, is a high achieving, and internationally-respected surgeon soon to become a life peer. Having completed his report, Professor Darzi has been drawn into Gordon Brown’s government as a junior minister and is charged with yet another review of the NHS as a whole. And the image of high-tech surgical incisiveness is being used to replace the messy business of democratic participation.
Brown’s enthusiastic adoption of Professor Darzi’s clinically-led, needs-based approach is a cynical smokescreen designed to bring the influential doctors onboard. The NHS infrastructure consists of an ageing stock of buildings being replaced by privately-financed millstones of debt. But the debt remains, and Brown’s commitment to the voracious needs of the City of London will ensure that the doctor’s enthusiasm for science is subordinated to it. Whilst Darzi is careful to say that the PFI-funded old-style hospitals can be reused in his revamped integrated service, he also offers up surplus land as a means to finance development. Estate agents and speculators will be rubbing their hands in glee.
Darzi’s claim to have sought the views of Londoners can hardly be described as comprehensive, nor did its methods match up to the Wanless "fully-engaged scenario" it references. Ipsos MORI conducted just 20 minute of telephone interviews amongst 7,036 London residents between 22nd September and 27th November 2006. Londoners’ health and social needs must be based on a fully-participative democratic process, involving residents, managers, doctors, paramedics and nurses, whose members in England in an historic move are about to launch a formal ballot on industrial action over the government’s below inflation pay offer.
Gerry Gold, economics editor