The delivery of healthcare will always be an emotive subject. When people are sick they are at their most vulnerable. Those of us who work in the NHS recognise this, and hence try to provide the best care we can. My frustrations, and indeed the frustrations of most doctors I know, are that the system often inhibits our abilities to serve our patients.
Most days of the week I hear about, or am witness to, rationing and clinical decisions being affected by a lack of money. Now, I realise that any healthcare budget will be finite, and that not every procedure or treatment will be available at the most convenient time for the patient. This is not my point. My annoyance is with a system where nobody appears locally accountable. It is the centralised, top-down, collective approach to healthcare delivery in this country that disenfranchises local people. Hospital closures, particularly those of small, locally-cherished institutions, are happening throughout the country. For example, a simple search on Google reveals on-going anger at hospital closures in Wiltshire and Hertfordshire. The balance sheets in each case apparently do not support the continued existence of local hospital sites. That may very well be the case, however, should not the decision to close these hospitals rest with locally-elected people? That would allow local people to use the democratic process if they so wished. In return for that, because the control of such hospitals would be locally determined, the ‘cost-benefit analysis’ would then become public knowledge. That, in turn, would allow local people to understand the financial realities of secondary care provision. Charitable donations would, I suspect, then follow, and these could be used to supplement locally-determined needs, i.e. local money for local care provision.
In my experience, when people feel that they own an institution they tend to look after it and, more importantly, respect it. The problem with the NHS is that local people do not ‘own’ their local hospitals. The sooner that national politicians make that change, the better for all concerned.
