Both workers in the Health Service and people in deprived areas would be better off with real NHS reform

The Telegraph reports statistics from the ONS showing that middle class professionals are outliving builders and cleaners by as much as eight years:






One of the factors that the report cited as possibly affecting a person's life expectancy was interesting:

"But the nature of people's jobs also has an effect. If you have autonomy and control over what you do, you tend to be in better health."

This logic implies that reforms that give public sector employees more autonomy and control over how they provide services, with accountability for outcomes to the public instead of to politicians, are very much in the professionals' interests.  This is possible within public services.  A study, Good people, good systems (PDF), by the Serco Institute found that when public services were managed by the private sector the staff found they had much greater freedom to act on their own initiative.  Here are some quotes from professionals who had moved from the public to the private sector (still working for public services):

‘Implementing change is much quicker.  In the private sector, you have the capacity to change quickly and to react almost instantaneously.  But it is left to individual [contract units] to react to the changing pace of the [customer] – head office is behind on these development most of the time.’

‘I am free to manage with greater autonomy, most certainly.  But that freedom comes with a price.  If you get it wrong – I’ve always accepted that if I’ve made a mess of my job I will be called to account at some stage.  It doesn’t have to be a nasty falling out; it’s just that if I run this contract and it doesn’t go well – either because we lose a lot of money, or the client is permanently unhappy with us, or we have a terrible safety record – it’s quite right that I should be called to account.’

Another factor contributing to poor healthcare outcomes among the poorest is that they tend to get let down most by the poor quality of British healthcare.  Dr. Thomas Stuttaford writes for the Times:

"In many deprived areas high blood pressure is still grossly underdiagnosed and treated poorly. Hyperlipidaemia – raised cholesterol levels – is ignored and few NHS patients know that their low-density lipoprotein levels are an essential indicator of possible trouble ahead. Breast screening, when compared with that of the rich, is too infrequent, discontinued too early and can even be desultory.

The average NHS practice still does not carry out or organise worthwhile cardiovascular assessment. It doesn’t measure blood sugar levels and renal function routinely, or determine the PSA levels of men so that it can diagnose prostate cancer in time for worthwhile intervention, or even understand the cardiac implications of progressive impotence.

Once a potentially lethal disease has been discovered, the quality of care that money can buy either in this country or abroad when compared with the standard NHS treatment is deeply worrying."

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