The Crimbleshank Choice

The New Labour NHS Spine

I took my car in for a routine service last week.

When I went to pick it up, one of the technicians came out to see me. They do not have mechanics any more. They are technicians. Mechanic-specialists I daresay. He told me that the camshaft crimbleshank needed replacing. Or something like that. He offered me a choice of crimbleshanks from any one of five different suppliers in the county. He said it is the company policy now to offer all their customers a choice. I do not know much about crimbleshanks and so I asked the technician which one he would recommend. He said the one from the supplier round the corner was as good as any. But he had to document on the computer that I had been offered a choice.

He sighed. Company policy. We have this new computer system. It cost £60,000, so it is policy to use it.

The NHS new computer system for crimbleshanks cost more than £6 billion.

When Dr Crippen started in General Practice, he could refer his patients to any hospital in the United Kingdom. He referred 95% of his patients to the two local DGHs both within ten miles of the practice. The other 5% went to a variety of hospitals. Some to Birmingham, a handful to London and one or two further a field.

GPs are educated consumers of secondary care. We are fortunate to have two excellent DGHs close by. We know who, within those hospitals, are the good consultants. Most patients did not ask for a choice. They relied on our expertise to select the right specialist. A few said they preferred hospital “A” over hospital “B” usually for reasons founded more in emotion (Mother died in hospital “A” so we do not like going there) than in common sense. They were easy to accommodate. We sent a very small number further a field, almost always because we, as the referring GP, wanted to tap into a highly specialist field of expertise not available locally.

When the Thatcher government introduced fundholding the freedom of choice for the referring GP was wrapped up in bureaucracy. But it was worth it. Under fundholding, the money followed that patient. Now it became important for hospitals to attract work from well-organised fundholding practices such as ours. The care our patients received improved.

New Labour does not like professional freedom. New Labour does not like “choice”. When New Labour came to power in 1997, one of the first things they did was abolish fundholding. Not only did they abolish fundholding, which was relatively new, but they also abolished freedom of choice of referral which we had had since the inception of the health service. We were compelled to send all our referrals to the local hospitals. We could not avoid the areas of lesser expertise. The hospitals no longer had to compete for our custom and the standard of service declined.

Now, in an act of brazen hypocrisy, they are telling the electorate that they are introducing choice into the NHS with the new “Choose and Book” system. Choice is nothing new. They are only giving back what they took away. Actually, they are not even doing that, because the image of “choice” is an illusion.

GPs will toe the line because they are going to be paid huge financial bonuses for offering patients a “choice” of five prescribed hospitals. The overwhelming majority of patients do not want or need this choice, any more than Dr Crippen needs a choice of crimbleshanks. They can and do say straightaway, “Well, what do you recommend, doctor”. And we recommend the best local specialist, as we would always have done. But the GPs do not have real choice of referrals because we are stuck with the five pre-selected hospitals.

Humbug.

It gets worse. The “Choose and Book” computer system is going to record all the medical details of the referrals and this information will be available for all on “The Spine”. (Read all about "The Spine" here)

So not only will you have to carry an identity card; not only will it carry the details of your latest Viagra prescription; now it will detail which hospital treated you for that attack of gonorrhoea about which you were trying to forget.

The NHS Crimbleshank Choice has cost you, the taxpayer, £6 billion pounds.