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'The NHS as a free market player turns the patient into a customer'

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No self-respecting blog about nursing and politics could miss the chance to talk about the new health bill passed a fortnight ago. The thing is I’m Scottish.

I’m training here and I can’t imagine working anywhere else.

I didn’t know much about the bill, simply because it doesn’t affect me. I’m also not the only one. I live with a member of the BMA and Royal College of General Practitioners, who were both heavily involved in gaining concessions in the bill, and he didn’t know much about it either. Devolution has already altered the landscape of the NHS, perhaps more than we previously realised.

The NHS in England is changing. This is inevitable. Firstly, giving more control to clinical staff rather than management is a positive thing - you don’t need to spend much time in a hospital to understand that some decisions are better made by those who understand patient’s needs.

The only problem here is that a medical or nursing degree in no way qualifies you to understand waste disposal or HVAC units. Yes, medical and nursing management will improve patient care, but the onsite canteen staff still need to be paid, and few doctors would view this as within their remit. Healthcare is a complex beast, needing at least some management by those who can see the big picture.

Competition is a rather more complex issue.

On the one hand, a bit of friendly competition is the cornerstone of a free market, driving standards up and costs down. This leads to the biggest question of all- should the NHS be treated as a market, as David Cameron believes, or is Nicola Sturgeon, the Scottish health secretary right when she says the founding principles of the NHS as a service should be upheld?

For nurses, the role they undertake could change as a result. At present, we are able to disagree (respectfully) with patients, challenge their lifestyles and habits and push for their good. The NHS as a free market player turns the patient into a customer. The customer is always right. It’s a small change, but a very distinct one.

The other major challenge regarding competition and choice is that is presumes patients have one. For those living in remote areas, the choice and competition is inevitably limited. Recruitment in rural areas is already a major issue for primary care doctors and nurses. Competition places rural services at a disadvantage. The government strongly denies ‘privatisation through the back door’, but this remains to be seen.

Student nurses need to be aware that the service they will enter will not be the same one they trained in.

It’s inevitable.

Lorna McLean is a final year student studying child health nursing at Edinburgh Napier. Lorna has a MA (hons) degree in politics and international relations.

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Readers' comments (1)

  • "friendly competition is the cornerstone of a free market, driving standards up and costs down."

    Many customers who use use rail and postal services, or have experienced hospital domestic services - and remember how they all were prior to privatisation - might disagree with this sentiment. Rail service providers, in particular, regularly stick their fingers up to customers, who, are almost certainly never considered to be right.

    Competition in the health service, like other services which are currently at the mercy of the free market, will be driven by what the cheapest provider can offer. Consider this when local hospitals and community services are run down or forced to discontinue when a provate provider wins the tendor for these services, a who will inevitably pay their nurses and support staff well below A4C rates.

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