WHY SHOULD CUTS BE MADE?
Because the level of government debt is unacceptable and will become an increasing burden to succeeding generations: it is an issue of intergenerational justice.
WHAT SHOULD NOT BE CUT?
The time that clinicians — nurses, doctors, therapists — have available to spend with patients. Why? More time means that doctors and other clinicians have more time to listen to patients and are more likely to arrive at a genuine understanding of the patient's predicament, and thereby a more accurate diagnostic formulation. More time means that the focus of the consultation is more on the person and less on the disease. More time means that patient and clinician are more likely to be able to work together in agreeing treatment plans that take account of the patient's preferences, values, and aspirations. All of these are known to improve the cost-effectiveness of health care.
Resources for research, teaching, and learning. Why? Because this is the future of medical science and health care.
WHAT SHOULD BE CUT?
The ever-increasing superstructure of monitoring, surveillance, and inspection within the health service. Why? Because there is no evidence of benefit, let alone cost-effectiveness. Poor practice continues to be exposed despite the burgeoning bureaucratic burden of multiple reporting and inspection.
The market in health care contracting. Why? Because the transaction costs cannot be justified in terms of improved services and any exposure to market forces exacerbates health inequalities.
The prodigiously expensive use of private management consultancy firms. Why? Because, yet again, there is no evidence of cost-effectiveness and much of the advice has proved misplaced and damaging.
In a universal healthcare service funded through taxation and based on social solidarity, the needs of the sick should be consistently prioritised over the demands of the well.
- © British Journal of General Practice, 2010.
