Betraying the NHS: Health Abandoned

Betraying the NHS: Health Abandoned by M. Mandelstam . Jessica Kingsley , London , 2006 , £14.99 (Hardback), 320 pp. ISBN 9781843104827 . The title correctly defines the evidence provided by Mandelstam on the current dismantling of the National Health Service (NHS). Although the author’s experience is mainly focused on his working area of Suffolk, there is plenty of bibliographical evidence provided in the text that demonstrates that New Labour is attempting to dismantle the NHS by privatizing the provision of its services and throwing it open to market forces. Mandelstam recognizes that the politically correct language of ‘choice’, ‘control’ and ‘independence’ achieved by central government pressurizes local councils into not providing services directly, but instead contracting them out to the private sector. Primary Care Trusts (PCT) that are planning to close hospitals claim that their proposals are about modernization and improvement, and not at root because of financial pressures. Another term that sounds good, until you look at the consequences for patients, is the obsession with targets, both clinical and financial. Mandelstam explains that targets and performance indicators paper over the cracks, declare false harvests and create a mirage of comprehensive, universal health service. The whole NHS has become in a sense disposable: its hundreds of hospitals and other organizations transformed into independent market actors must now increasingly fend for themselves financially. They are becoming answerable to market forces rather than to elected ministers. The increasing scope of Private Finance Initiative, and the financial burden it generates, means that this is perceived to be increasingly responsible for the size of the NHS debt, together with related bed closures and service cutbacks. The book provides horrific evidence of a lack of interest by the Department of Health (DoH) in the views of local people as well as a complete lack of accountability. The DoH refused to hand over 5500 letters and postcards and an 11 500-signature petition to West Suffolk PCT in the final decisions about closing Sudbury community hospitals. This episode quite reasonably led the author to conclude that we no longer have a ‘national NHS’, let alone one that proceeds on vaguely democratic lines. A main concern of the author is the loss of local services to elderly people. Dumping of services and patients onto local councils by the NHS does not work because Social Service authorities have no legal remit nor expertise to deliver health care and many of them are in serious financial difficulty. Patients are being increasingly treated like financial and business units, as NHS trusts endeavour at all costs – both financial and human – to meet targets and save money. Perhaps lessons can be learnt about how financial and political agendas, both rushed and covert, can undermine the effectiveness of NHS decision making. Somewhere, amid the welter of targets, indicators, new technology and hard processing of patients on conveyor belts (officially known as ‘care pathways’), what some would call old-fashioned ‘real care’ appears to have slipped from sight. This might appear not to matter; if it is old it must be bad. The problem is that so-called ‘old-fashioned’ real care actually works because it recognises people as individuals, rather than business units or financial bundles. This book is essential reading for staff and users of the NHS, in order to understand the constraints on the provision of an accountable publicly managed service and hopefully to alert readers of the need to keep our NHS public.

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