Competitive Hospitals: Good or Bad?

One of my greatest pleasures out here, and a small link to the motherland, is a subscription to The Spectator, given to me for Christmas. I don't consider myself a raging Tory, but there are always some thought provoking articles to be found, and although I sometimes shudder at the overtly partisan nature of the politics, I forgive it nevertheless. Of course we are grossly behind because the magazine gets sent out, via our BFPO address in Washington, from England, which means I am currently reading the April 10 edition, which is a little frustrating. But getting it sent out is a lot cheaper than paying international subscription rates.

Anyway. Despite usually taking the more strident political articles with a pinch of salt, I was a little disturbed by something in an article in the aforementioned April 10 edition by Michael Heath entitled The Case for Cameron. Heath refers to the Tory offer of independent education for all, specifically allowing anyone to set up a school. "...it is encouraging that Mr Cameron would adopt this model more generally," writes Heath. "Under his government, public sector workers would be allowed to stage what is, in effect, a management buyout of their own division. They could operate for a profit, offering services to companies as well as government. There are increasingly hopefully signs that this will be adopted in health, too. As Oliver Letwin recently put it, 'Hospitals compete for patients, schools compete for pupils, welfare providers compete for results in getting people out of welfare and into work.' Such a vision is nothing short of revolutionary."

Well actually, it's not entirely. Because the one part of that statement that worries me the most already exists here in America: the part about hospitals competing for patients. Over here, it is not uncommon to see giant billboards at strategic intervals along the motorway, advertising, say, Lawrence Memorial Hospital as the place to go for cardiovascular experts, or Children's Mercy Hospital as the best place to take your sick child. On the radio there is a particularly odious ad featuring a syrupy sounding woman talking about how much she loves playing with her grandchildren - but how she nearly didn't get a chance to after a heart attack several years ago. Luckily she was taken to the Blah Blah Hospital with its expert cardio care and her life was saved, etc etc etc.

I find such adverts distasteful in the extreme. Perhaps it's my NHS upbringing (my father is a doctor and yes, he does do private work but the bulk of his patients are NHS) but I have a firm belief that a certain level of care should exist at all hospitals, and that the most important thing in an emergency is to get to the nearest one, not worry about telling the ambulance men as they load you up that you want to go to xxx Hospital please, because it's got the best surgeons. Of course there are some doctors who are more skilled in their particular field than others, but to advertise the fact seems unnecessary, somehow - not to mention playing on the fears of the often worried well - because after all, if it really is an emergency you probably don't care where you go. But over here, healthcare is a business - and a pretty dirty one at that. To contemplate the NHS going the same way is fairly horrific, not least because it is a slippery slope to some of the horrors that exist within the American healthcare system: doctors recommending surgery because it means they can charge a higher fee, or inducing babies so they can get back onto the golf course. I exaggerate, of course, but there's a truth to it. Oliver Letwin should watch what he says about free markets when it comes to healthcare.