Why patients are not consumers.

To all the private health industry nobs at the CIVITAS debate last month, I re-emphasise.

The NHS is not for you!

This doesn’t just mean that your market based intrusion is unwelcome, but just as importantly;

Patients are not like you and me.

They are more likely to be very young or very old, have chronic mental and / or physical illnesses, be on multiple medications, have personality and mood disorders including chronic anxiety, be illiterate or poorly educated, not speak English, to be poor, and suffer social deprivation including unemployment, poor housing, lack of space and exercise, to smoke and drink excessively, abuse drugs and so on. That’s why 10-20% of our practice list accounts for 80-90% of all our appointments.

Patients; those people for whom the NHS has greatest responsibility, are a vulnerable subset of the population and they lack the autonomy –determined by knowledge and power- that the rest of us have.

Markets convert citizens into consumers and lead to a social divide in which the autonomous rise to the top. If you create a market in healthcare, then patients –those who need healthcare- will fall to the bottom and the social divide –which has worsened considerably over the last 30 years (see Steffan Collini: Blahspeak London Review of Books April 8th 2010) will be mirrored by a widening health divide.

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