Published: 03/11/2005 Volume 115 No. 5980 Page 2
For the best part of a decade, ministers have been talking about how the NHS must change to meet the demands of a consumer society.
Health secretary Patricia Hewitt was at it in a speech to the Fabian Society in August, which defended choice and attacked the monopoly of the NHS. Sitting through the speech, I found myself wondering: just what country does this woman live in?
Where is this wonderful consumer paradise, with fantastic services that put the NHS to shame?
I do not recognise it. Yes, the cash point has given us 24-hour banking, but who thinks call centres are good? And do not even get me started on dealing with utility companies.
I suspect the gas and electricity industries are what ministers have in mind when they talk about the need for public services to move with the times. After all, gas and electricity companies operate in a market that is regulated for price and quality, but in which consumers can choose from many providers.
They operate whizzy websites, setting out their wares. They run call centres, through which it is possible to pay bills or book special services.
But try to get them to, say, move a gas meter or a mains electricity cable, and you'll find the system doesn't work. Foolishly, I've tried to get both jobs done in the past six months.
Moving the gas meter took seven contractors or subcontractors. First, I had to find the company in charge of the gas pipe running from the road to my house. It subcontracted digging it up to someone else.
Then I had to find the company in charge of the meter, which sent another subcontractor to move it and connect it to the relaid pipe.
And then I had to find a Corgiregistered plumber to connect the other side of the meter to my domestic piping. Except that I had to do that after a bank holiday without gas, because none of the call centres booking in the work had managed to tell me I needed one.
Why does it take seven companies to move a gas meter? Choice, love.
Sometime back in the past, it was decreed that the gas board was a bad thing, and patients really wanted a choice of pipe and gas supplier.
There are parallels here with the NHS. In order to create choices, the government is creating a more diverse provider base - or even more fragmented system.
In this bright new world, there will be regulators such as Monitor setting the rules, and bodies like the Healthcare Commission checking up on services.
There will be foundation trusts, with whizzy websites, and electronic booking systems, so people can bone up on local services and exercise their implicit spending power.
However, the danger is that many will end up falling through the gaps between contractors.
What consumers and patients need is good agents; people who know how the system works and can hustle novices through it.
A few are emerging. In the utilities sector, there are websites that compare prices and take some of the pain out of switching provider.
In healthcare, both the NHS and commercial organisations like Dr Foster are entering the information market. But services to help people find, interpret and then act on that information are thin on the ground.
One of the lessons of the early booking pilots was that patient advisers were needed just to get patients to understand the concept of choice and to arrange services to ensure they could exercise it.
Yet ministers have indicated it will be up to primary care trusts to decide whether to create similar services as choice takes off. Even if they do, It is unclear where information and IT support will come from.
This is not an argument against choice. It is an argument against assuming competition, information and booking will, by themselves, create a much better system. The lesson of the utilities is that it will not.
Meanwhile, I am still waiting to get my mains moved because the contractors turned up after a sixweek wait and promptly went away again because my builder had laid grey ducting for their cable to go in.
Black ducting is what I need, apparently. I would have bought some this weekend if the stock showing on the computer at the builders' merchants had actually been in the yard. .