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Mark Radcliffe: ‘Choice means business interests replace principles’

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One of the annoying things about getting older is hair growing in your ears. For us boys, ear hair and its annoying cousin, nose hair, are a challenge. I wonder if there are some hair follicles resting just behind the temple that are activated on our 40th birthday just to annoy us, which grow from both ends toward the light. Quickly.

Sometimes you can start a conversation devoid of ear hair and finish it with one very long, rope-like strand emerging like a triffid and reaching for the window. It’s as if your body has become bored of you, the way you once became bored of double geography, and it’s started testing what bits it can make ache and finding out from which unexpected places it can sprout unwanted hair. Still, look on the bright side, I say. At least I don’t have hairy eyes yet.

Powerlessness. It’s a recurrent theme. There are many things that happen to us that we don’t get to choose. From prime ministers to ear hair. From global warming to cellulite. But – and this is another recurrent theme – we do get to choose what to do with them once they are dumped into our lives. Ear hair, for example, we can cut or perhaps plait.

Lord Darzi’s overhaul – we now seem to have three overhauls a year and a ‘radical shake-up’ every fortnight – is being rolled out all over the place to emphasise that its proposals are focused on local needs. So we continue the march towards every street having its very own tailor-made NHS.

At the heart of the overhaul is the ever-nebulous notion of ‘patient choice’. This is a slogan with power because it cannot be easily measured and because, if you consider it inappropriate for a health service, you stand accused of being ‘anti-choice’ which is right up there with wanting to kill fluffy kittens. If patients don’t want it, it won’t happen, was Lord Darzi’s message.

The premise is give some people what they might want and perhaps they won’t notice they aren’t getting what they need.

One largely unspoken problem of the perpetual ‘overhaul’ of the NHS is the growth of interested organisations, from modern trusts with their ‘brand identity’ and corporate preoccupations to private firms with their desire for profit and hard-to-please shareholders. With this comes more administrators, more managers, more assorted directors and more confusion. Too many organisations, with too many layers of management and too many protocols.

So, what do we have? A lack of any meaningful driving principles and lots of potential business opportunities sprouting like ear hair all over the place. The overhaul amounts to a declaration of ‘let the people decide’. But who is convinced they want to?

If the time and money that has gone into reconfiguring services had been invested in providing them, patients might be happier. And services might be better.

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