Darzi for London?

I was a platform speaker on behalf of Unite at a London-wide health conference held yesterday. The conference was to look specifically at Ara Darzi’s proposals for a major reorganisation of health care in London.

I argued that Darzi’s proposals will result in far worse health care for Londoners. Darzi (or McKinsey, the consultancy rumoured to have actually written the proposals) resorts to ‘motherhood and apple pie’ rhetoric. The plans are supposedly about ‘improved care from the cradle to the grave’ and ‘an NHS fit for the future’. Reading Darzi’s report feels a bit like death by sound bite.

The problem is that the rhetoric is cover for worse health care. Darzi wants to get rid of the existing network of GP surgeries and health centres, and replace them with vast ‘polyclinics’ – each staffed by around 35 GPs, offering diagnostic tests, minor surgery and emergency surgical procedures, nursing and therapy services and so on.

This sounds attractive – but in practice would mean sharply reduced access to primary care for the people who need it most. There would be 3 or 4 polyclinics in a typical London borough, and that means patients would have to travel to get there. The people who make the most use of primary care are older people, people with disabilities, and parents of small children. If you’re an 85 year old with severe arthritis, you want to see a local GP as close as possible to your own home. The last thing you can deal with is travelling a couple of miles to an appointment. And very few primary care appointments require minor surgery or fancy diagnostic tests. Most people want to see the local GP who knows them, or the local practice nurse they feel comfortable with. Care in the community will end up meaning care in your own bedroom, with your husband or wife doing the caring.

Darzi carefully fudges the question of what his proposals for acute hospitals will mean, by talking about ‘vision’ rather than practicalities. The reality is that a transfer of services out of hospitals, together with Darzi’s planned running down of District General Hospitals, will lead to a closure of A&E units and maternity units. In today’s NHS, run on business lines, the loss of revenue will also leave hospitals making unplanned service cuts on an almost random basis, just as we saw in 2005 and 2006. How does this benefit patients?

Darzi is a strong supporter of privatisation, and wants to privatise primary care, the management of long term conditions, and even commissioning – so the private sector gets to choose which services the NHS will provide, before commissioning those services from their mates. This is set to be a disaster for health workers and the patients for whom we care.

The proposals add up to worse community care, worse hospital care, and big bucks for big business.

This was my position. The Unison full time officer on the platform took a different view. He said that this was what we should be doing, that the proposals made sense, and that this was about reducing inequalities. You couldn’t spot that this man was a trade unionist – he was clear that he was there to defend Government policy on the NHS, and that’s exactly what he did. It’s disappointing that union full timers can get so confused about whether their job is defending their members or defending Gordon Brown.

One of the other speakers was the Chair of a Foundation Trust. She said she was completely sceptical, that Darzi’s proposals were finance driven, and that the rhetoric was about providing a comfort zone around cuts and reconfigurations. She was absolutely right, and it was great to hear such honesty. How strange, though, that an NHS bureaucrat can be a far better defender of the health service than the officer of a leading public sector union.

There are, of course, wider political issues here. Too many union leaders have lost all confidence in workers changing things for ourselves. They believe that all we can hope for is the occasional scrap from a neo-liberal Labour Government. That’s a disaster for our members at a time when the Government is on the offensive.