Here in the UK, we are increasingly seeing biopower at work in the national health system (NHS). A target driven culture allows patients to be treated like numbers or labelled as disease entities. It is common place to hear of people referred to as ‘Diabetics’ or ‘Asthmatics’ rather than understood as a person, with a name, in a particular life context and set of relationships who has diabetes or asthma. In my area of work, that of general practice, a huge part of our income every year comes through meeting ‘QOF’ (the quality and outcomes framework) targets. The idea behind such targets is to ‘drive up standards’ and ‘improve patient care’. In real terms, however, people can end up having various changes and increases to their medications, so that their blood pressure meets a government target, for example. The ill effects of this, particularly on old people has been recently well documented. Clinicians work hard to get everybody’s blood pressure below a certain value, but due to a lack of research and understanding behind the targets set, especially for people over the age of 75, lowering the blood pressure too much has been causing an increase in falls, fractures and long hospital stays! This is one of many examples where ‘payment by results’ is actually subtracting from patient centred care.
In the recent top down re-organisation of the NHS, which has cost more than £2billion, despite a government promise that such a reorganisation would not happen, more services are being driven out of a traditional hospital setting into the community with no extra resources or time provided to do this work. The new clinical commissioning groups (CCGs) are the new local governing bodies, which have replaced PCTs (primary care trusts). The idea behind this is that GPs, clinicians who know their patients and areas well, should be those who commission services rather than non-clinically trained managers, as they potentially have a better knowledge of the needs of patients. However, it transpires that if the government don’t like decisions being made, they can simply dismiss a board and replace it with another one which will comply with their wishes or cause them less of a political headache.
The implication of the EU-US trade agreement has opened the NHS in a way, like never before, to the forces of the free-market. This is based on a philosophy that competition drives up standards of care, and that private providers should be able to bid for services. At first this sounds like a credible and plausible idea. If another provider can offer the same service for less money, surely this is a good thing? Actually it is problematic on two levels. Firstly because the philosophy is deeply flawed. Competition does not drive up standards. It increases stress and breaks apart well integrated services. It destabilises services which currently work well in a symbiotic manner. For example, if Spec Savers offer a cheaper hearing aid service than the local hospital, then they can win a bid to provide this service. But it destabilises the hospital audiology department, which then has a knock on effect to the ENT department. The private company benefits, but in the long term the local population does not. Secondly, when companies limited by shares become the providers of care, care begins to play second fiddle to the need to make money. And here is a major stumbling block. The marginalised poor and the chronically sick do not make good financial sense, and share holders who live in another part of the world care little for their needs, but care a lot about making more money for themselves. So, we will find that those who need care the most will be unable to access it, as greed becomes the driving force. This is sadly proven in the US health system, where this philosophy is rife and 50 million people cannot afford healthcare and 40,000 people died last year as they could not afford the operations they needed. It is only media hype that causes some to believe the US to have the best health system. Most consider it to be inequitable and highly wasteful of resources.