Andrew Lansley, dangerous idiot


When the Tories came to power (yeah, whatever), the party faithful and the new MPs were the most right-wing they had been in their entire history. They've liberalised their views on some social issues (they're now pro-gay, they say, although they still hate single mothers and other social deviants) but economically, they're neo-conservatives in the George W Bush/Tea Party stylee.

Unlike the neo-cons in the US, they know that the British people are basically centrist, so they have done a good job of hiding the breadth of their plans for selling public services to their friends in big business. We Brits don't tend to like that type of thing.

With the NHS, the Tory plan seems to have tested well in focus groups before the election. In broad terms, it does indeed sound good. Instead of remote boards and faceless managers deciding everything, the job will be handed to your friendly, cheerful, local GP to do. And, if he won't do it, well, don't worry, other groups (private businesses, but we won't say that loudly) can do it. All's well.

Except it isn't. This is a radical switch in power from those with a lot of knowledge to those with none. By making hospitals dance to the GPs' tune, the experts – specialists, consultants, nurses – in given diseases will have to do what the GP – general, jack-of-all-trades – wants them to do. And I've just experienced this.

I've been having tests at a local hospital. They're all negative. Yesterday, I saw the specialist and she was downright hostile. Why, she demanded, was I wanting all of these pointless tests? What was I trying to prove? Well, nothing. I didn't want any of the tests. My GP wanted me to have them. I really don't have the medical knowledge to decide whether the GP is seeking pointless tests or not.

She pushed further into my notes and wondered if they were incomplete. Did I know what the results were for such-and-such a test? Did I know what level something-or-other was at? No, I didn't, because I'd never had those tests. My GP had seized upon one symptom and was having the hospital probe that symptom over and over again; what he wasn't doing was attempting to find a root cause for all the symptoms. He hadn't stopped and looked at the whole body, he'd skipped to the likeliest outcome based on one symptom and passed me on to the hospital, rather than paying for the actually-needed other tests.

The specialist at the hospital will now be writing him a stern letter, reminding him to do his job fully first in future.

And here's the rub: when Andrew Lansley's "reforms" to the NHS go through, the specialist will never again be able to write such a letter. The power will move from her, with her a-lot-about-a-little knowledge, to the GP, with his a-little-about-a-lot way of working. The hospital will have to keep performing the pointless tests on one symptom until the GP is satisfied. The patient – me – gets a worse deal than ever, being poked and prodded and taking time off work for tests that aren't needed. The GP gets to make expensive financial decisions in the 4-minute slot allocated to each patient every day along with the medical decisions that we'd rather he made in that tiny time. The specialist doesn't get to specialise; the generalist has to do the impossible and get more specialised about more and more generalities.

This is all bad. Give me a remote, faceless bureaucracy any day.