It is time to close the gap between public discussion and political practice in New Labour's NHS, says a GP in this week's British Medical Journal (The growing gap. BMJ 334;670).
Public discussion is directed towards improving services for patients. Yet, on the far side of the gap, we have the accelerating privatisation of healthcare provision, and a medical profession that is being simultaneously coerced and demoralised for political ends, argues Dr Iona Heath.
"A weakened medical profession may be more politically compliant and less able to resist the distortion of the health service for commercial ends, but it cannot serve patients well," she says.
"Consider the chaos surrounding the new systems for recruiting young doctors into specialist training. The whole process contributes to the political objective of enforcing conformity and marginalising dissent, which in turn damages patient care. How is medicine to continue to attract high calibre applicants if this sort of career path awaits them," Dr Heath asks?
"Only if doctors have the freedom to explore and explain options can patients be free to make their own decisions," she writes. "If doctors are encouraged to offer standardised care, as they are under their new contracts, drug consumption rises and patient choices become constrained."
"Here again we find the growing gap," she writes. "Public discussion promotes self-determination and free choice for patients, but political practice dictates that only those choices that concur with the interests of the politically and economically powerful are actively supported."
"Society needs the most able young people to want to study medicine and then to use their knowledge and skills, independently of political and economic power, for the benefit of all," she says. "Has this suddenly become an impossible aspiration? It is time to close the gap."
To view the full paper, go to: http://press.psprings.co.uk/bmj/march/obs670.pdf