Any universal, free service will have two potential flaws. First, practitioners may feel they are doing people a favour in providing it; second, most patients will have no real sense of the value of the services they are receiving.
Patients will rightly no longer accept the brusque, off-hand manner of some in the medical ‘old school’. Poor service should be challenged and patient choice extended. But this is a two-way street: patients must also face up to their own responsibilities. Nursing and clinical staff are to be respected, even if they are not in a position to give you what you want, when you want it. Services may be free at the point of use, but that doesn’t mean they can be used casually.
Failure to get this doctor-patient relationship in better balance risks leaving the way clear for the right to argue against collective provision of healthcare funded through tax. They will cite unresponsive service and waste as endemic features. But, thankfully, we have bought ourselves time against them.
Slowly but surely, Labour in government is proving to the doubters that the NHS model can provide a decent level of service. However, as far as the public is concerned, the jury is probably still out on whether that same model can go up a gear and deliver the highest-quality care that meets modern expectations.
I firmly believe it can, and that is a tantalising goal for any politician of the left, because it will set up the NHS for good against the insurance advocates and voucher vultures. But it depends on finding solutions to those two historical and interlinked flaws.
Ending the ‘like-it-or-lump-it’ delivery culture is only possible if valuable NHS resources are used more efficiently. For instance, how can we give people choice over when they see their doctor when 10.5 million appointments with GPs are missed every year? How can we meet the ever-increasing demand for prescription drugs and new treatments when so many prescriptions are dispensed unnecessarily?
To our cost, the privations of the Tory years created a vicious circle in the NHS and a dysfunctional doctor-patient relationship. Because people received unresponsive services – being left to wait for hours in A&E or wasting a work day hanging around for an outpatient’s appointment – many understandably felt no corresponding duty to play fair by the NHS.
Our challenge is to turn that round. As people can see and feel the NHS improving, and leave it feeling gratitude rather than resentment, it is more likely that they will be conscientious and careful when using services, less likely to ring up in a rage or fail to show. My sense is that this is starting to happen. Even in my short time in parliament, I have seen a drop in NHS-related complaints. But our time and intellectual energy now needs to be focused on primary care and the GP-patient relationship.
Ways have to be found to encourage patients to use resources more responsibly. Printing the actual cost of every prescription medicine on the label might be a simple start. Other more radical options could include compelling every patient to make some financial contribution, however small, to the cost of their prescription medicine as part of an overhaul of the prescribing system and a system of fines or other sanctions for missed appointments.
But such measures could only be considered once we have made much more progress on improving primary care: reducing GP vacancies, providing more convenient surgery times and better premises.
This is starting to happen with the LIFT scheme to modernise primary care units that, coupled with the new GPs’ contract, may open up much more imaginative possibilities. Greater community involvement in the management of premises and delivery of services – as is the direction of travel elsewhere – could do more than anything else to foster a more modern doctor-patient relationship.
For the first time in its 56-year history, the NHS is poised to deliver its full potential for the British people. But it will only do so if we are honest about its weaknesses and tackle them head on.