Patients, Power and Responsibility: The first principles of consumer-driven reform.

 By John Spiers. Radcliffe Medical Press; 257 pages; £27.95

“Discontent is the beginning of the success of a nation.” So opines Oscar Wilde’s Lord Illingworth in A Woman of No Importance.  If this maxim, as quoted in ‘Patients, Power and Responsibility’, can be applied to the NHS then we are surely ready to succeed!

Everything is improved by consumer-driven reform of healthcare. This is the central argument of John Spiers’ wonderful book.  There will be better treatment – guaranteed – , prompt service, reward for high performance and, best of all, self-responsible patients.

His vision is one of unimaginable freedom in UK healthcare, where governments simply make the rules but the power is wielded by competing, independent care associations of patients who insist on outcome-based healthcare.  Ultimately,  fund-holding patients have “the ability and freedom…to be in charge of their own life and their own care.”

Spiers sets out his principles in a detailed and scholarly way, focussing on the real meanings behind emotive words, such as ‘equality’ and ‘choice’.  He exposes the impotence of patients ‘having a say’, when they have no financial muscle to flex.  Consumer-driven reform means informed and intelligent patients making choices not only about their care but also about their lifestyles.  There would be incentives for preventive care.

This is no ‘pie-in-the-sky’ wish list.  Practical solutions are described, based on evidence.  Think of the optics market in the UK, where there has been an explosion of choice, improved consumer satisfaction and still, many opticians offer free eye-tests!  This success could prove a model for other sectors.

But what of chronic expensive illnesses?  Spiers answers this with a basic, guaranteed ‘core’ package of care.  The middle class will still pay for the less well off, but individuals will be encouraged to top-up their provision.  International comparisons are made, with Switzerland and Canada mentioned favourably.  Indeed, the gap in total health spend between the UK and other developed nations is largely accounted for by the underdeveloped independent sector in the UK.

I thoroughly enjoyed John Spiers’ book, and continually found myself exclaiming things like, “That’s absolutely right!” and “See, isn’t that what I’ve always said?” 

I would encourage anyone involved with healthcare in the UK to read this book.  It provides an optimistic and realistic way forward, free from the stultifying effects of political dogma and out-dated paternalism.


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