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Dr Michelle Tempest: Polyclinics could spell the end for health localism


Dr Michelle Tempest, a psychiatrist, blogger, and editor of the The Future of the NHS, fears Brown's Stalinist approach to the healthcare delivery.

‘The invisible hand’ metaphor was first coined by the economist Adam Smith, to demonstrate how in a free market, an individual pursuing his own self-interest, tends to also promote the good of his community, through a principle he called ‘the invisible hand’.  The clunking fist metaphor is an apt description for Gordon Brown, sapping up any individual instinct to do better, and replacing it with a state, ‘top-down’ approach.  This Labour ethos leaves a ‘tight bureaucratic straightjacket’ in its wake, and pervades everything Gordon Brown has put his hand to.  Schools and teachers lack the power to keep order, with legal bureaucracy preventing the exclusion of disruptive pupils, who consequently distract the rest of the class.  Even planning powers have succumbed to Labour micro-management.  Responsibility set to be transferred back more centrally, to unelected ‘Regional Development Agencies.’  One can almost see that clunking fist smashing down into the very heart of a local community, dispersing community spirit.   

And does the clunking fist ever learn?  Even after the unforgettable data scandal where 25 million private records went missing, following a systemic failure at HM Revenue and Customs (a body set up by Gordon Brown to ensure greater control over Britain’s tax system) the expensive ID card scheme still has the green light.  It seems to highlight a stark problem in Labour ideology, where focus is solely on data, rather than on people, or trying to solve problems.  As Nick Herbert MP summarised, “A Government which tries to control everything but cannot run anything.”

So, what’s next?  Is the clunking fist set to create a new medical condition -  ‘Bureaucratic Paralysis’?  The past ten years have overseen vast sums of money poured into the NHS, wasted on top-heavy, bureaucratic systems and squandered on NHS white elephants, such as electronic records.  Seemingly money merrily spent on numbers, targets and quotas; anywhere but much-needed patient care.   

The next Labour plan is to centralise GP services by enforcing polyclinics. In some constituencies they may be welcome, but in other areas polyclinics are neither wanted nor needed. Andrew Lansley MP has described how polyclinics “would completely destroy the relationship between local people and their family doctor.”  The one-size-fits-all mentality could prove to be the nail in the coffin for ‘health localism’, where local communities could decide how they want their health needs met.  Instead, polyclinics are to be uniformly built across the country, ignoring a recent survey, which showed that nine out of ten patients favoured current practice over the polyclinic model. Dr Steward Kay (GP) stated:

"the smaller and more local traditional general practice, which has evolved with its community, can more easily serve the needs of old, young, and vulnerable people. Continuity of care and personal care are more difficult to provide in large units.... I truly believe we need to keep GP practices local and use the bottom-up approach."

Polyclinics have so far been allocated £250 million from the Department of Health budget, although this sum is barely expected to cover the cost of the new buildings.  Government plans for new supersize polyclinics and health centres will leave a £1.4 billion black hole in public finances - unless other GP surgeries close. So, will Labour repeat its habit of throwing NHS money away from patients and into a bottomless pit?  Preferring to spend taxpayer’s money on polyclinics, proudly paraded by Labour spin-doctors, but with little evidence of patient benefit?  As Tobias Ellwood MP (who requested the petition against polyclinics) stated, “polyclinics resemble the Emperor’s new clothes; naked political ambition but lack material substance.”   

I believe we need to support areas that choose to oppose the polyclinic model, encourage local primary care initiatives, free current services from red tape, and say no to central control from a dictatorial Prime Minister.  Otherwise, polyclinics may prove to be the clunking fist knocking out the invisible hand.


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