Wednesday, August 30, 2006

Postcode lottery - or a new localism?

Let me make one thing clear - I share the view that infertility is a terrible thing, blighting lives and denying people the opportunity to do something many take for granted, i.e. raising a family. Unfortunately, the debate today, whereby women are encouraged to complain about the lack of access to IVF treatment in their area, raises a question, the answer to which is going to be unpopular, whichever way you cut it.

It is claimed that access to IVF treatment varies depending on where you live, and this is clearly true. However, this is based on choices made by Primary Care Trusts, something that, as a liberal, I support. It should be the right of a Primary Care Trust to cut its limited cloth according to what is felt to be best for the community as a whole. In some areas, cancer is a priority, in others care for the elderly. You cannot prioritise everything.

I am fascinated by the suggestion that service and access levels should be the same across the country. If you asked these same people to comment on the increasing centralisation of government, they would be the first to complain about interference from Whitehall. Ah, the joy of contradiction... so, we can obviously expect the Conservatives to be in favour of standardised access...

So, should we seek standardised access to healthcare on a national basis, or do we encourage Primary Care Trusts to reach out to the communities they serve to determine what is most desired in terms of service and access levels? The answer, in my mind, is a combination of the two. There should be nationally set guarantees of minimum levels of access and service, with Primary Care Trusts free to invest in additional, top-up services based on the perceived needs of their communities. But this all hinges on proper community involvement - they're our services, we should engage in the debate.

I was, I admit, somewhat annoyed by the comments made by a woman interviewed by the BBC, stating that "I've worked all my life and I've paid my NHS contributions, so why can't I have IVF treatment on the NHS? It's due to finances, oh yes, and my weight...". She's two stone overweight (her claim, not mine), and such circumstances increase significantly the risk that IVF treatment will fail - wasting NHS funds and denying someone else access to treatment. If healthcare is to be rationed due to limits on the amount of funding (your choice, Mr and Mrs Public, you can pay more tax if you want...), then clinical factors are the best and only fair criteria to apply when deciding the appropriateness of treatment.

I don't have children myself, never wanted them, and don't particularly like them (although I make an exception for my own family - they're all angels...) but admire anyone who has the desire and patience to bring them up themselves - it isn't easy. But there are children out there in need of adoption, and they deserve an opportunity too...


Tristan said...

This hilights the problems with the NHS.
It is by nature a centralised system for a start.

The other big problem is that people expect everything for free and expect the best care, yet NICE and PCTs have to balance things.

Its why I'm starting to favour a system based upon individual compulsory savings (government backed if you don't have enough income to save the full amount, then government will make it up through taxation). Then people can pay for healthcare out of that and choose to spend their money how they like (where they like). All backed by catastrophy insurance to provide cover for catastrophic events which can't be paid out of the savings.
It raises many questions, like how do you transition from the NHS to this, what do you do for children etc.

Unfortunately its probably too radical for the public to accept (without the collapse of the NHS) especially given the way we're always told the NHS is 'the envy of the world'...

I just hope we can find a solution before it really hits crunch point...

steve rutherford said...

You have asked a key question

"So, should we seek standardised access to healthcare on a national basis, or do we encourage Primary Care Trusts to reach out to the communities they serve ... ? "

My answer would be: Yes, but ONLY IF YOU TRUST THEM. Unfortunately, I don't.

Remember that PCTs (and every replacement I've heard suggested) are quangos.

The 'reaching out' is likely to be limited polling or questionnaires that only give the options that the PCT wants to consider: Nothing difficult to achieve; nothing controversial; nothing specific.

Don't forget that PCT managers ARE partly responsible for the mess than many trusts are in.

Personally I feel the choice is with a completely customer-led system where each doctor, surgery and hospital is in competition or a genuine national health service where tight targets are rigidly enforced.

The current half-way house between a national and local system leaves everyone confused and further quangos are not the way to go.