Recent Health Articles

Let’s go beyond the Horsemeat scandal – our food should be slavery free too

by Guest     February 19, 2013 at 2:28 pm

by Louise Woodruff

The current horsemeat scandal raises serious concerns about our food supply chains, as Fraser Nelson argued so well last week.

The same economic pressure to supply this food cheaply applies to the labour costs as well as to the cost of the raw material. There are serious questions about the complex nature of the supply chains and the conditions and experiences of those low-paid workers who produce, process and pack our food.  

We already know that migrant workers are being exploited in different parts of the food industry. The workers in our study told of:

  • paying upfront fees to work;
  • excessive workplace surveillance, including problems taking breaks;
  • overcrowded tied accommodation;
  • racism, threats and bullying;
  • fear of dismissal that ensured workers remained compliant; and
  • a range of infringements on pay. 

 Most of this exploitation was linked to informal gangmasters. Other evidence shows that long supply chains and high levels of subcontracting facilitate forced labour.

The Equality and Human Rights Commission (EHRC) conducted a wide-ranging Inquiry into the Meat and Poultry Processing Sectors.

The inquiry found there was widespread mistreatment of agency workers, especially pregnant and migrant workers. While progress has been made by the industry in a number of areas, EHRC points to several areas where problems persist: discrimination against agency workers, and workers not being able to feed in confidentially to ethical audits carried out by supermarkets.

The UK Human Trafficking Centre estimates that around 19 per cent of ‘trafficking for labour’ exploitation victims are in the food and processing and agriculture sectors.

These extremes of labour exploitation are thankfully only found in a small segment of the huge UK food industry. Indeed, the supermarkets have put in place a system of ethical auditing to inspect the workplaces of their suppliers and support the Gangmasters Licensing Authority, which plays a vital role in tackling unscrupulous labour providers.

However, as the evidence, plus cases like that recently exposed in Kent show, there remains a serious problem.

This horsemeat scandal should act as a catalyst for retailers and caterers to re-examine their supply chains, to ensure our food is not only safe to eat, but also slavery-free.

Louise Woodruff manages the Forced Labour programme at the Joseph Rowntree Foundation

Bookies are targeting the poor with gambling’s crack cocaine

by Guest     February 15, 2013 at 9:45 am

by Matt Zarb-Cousin

Take a walk down any high street these days and you’ll probably see a cluster of betting shops. Pack-like, they feed off of the customers of the others, safe in the knowledge that there will always be demand for their most addictive product – the FOBT.

The FOBT, or Fixed Odds Betting Terminal, is a touch-screen twin-screen roulette and casino gaming machine found in the bookies. They have been described as the “crack cocaine of gambling” because of the high stakes and high speed of play – it is possible to bet up to £100 every 20 seconds. Law limits each betting shop to four, so bookies open as many shops as possible. This is why we get clustering, and it’s not surprising when each FOBT is worth over £900 per week in profit to them.

But bookies are a business, they exist to make a profit, what’s wrong with that? Well, a number of things.

Firstly, research commissioned by Dispatches and carried out by Geofutures found there to be more than twice as many betting shops in areas of high unemployment than in areas of low unemployment. The trend across the country suggests they are targeting the poor.

Secondly, the FOBT-driven proliferation of betting shops in some of our most deprived areas is not creating jobs. In 2010, there were 8,822 shops employing 57,319 people. Last year, with 9,128 shops the industry creates just 54,449.

A magnet for violence and anti-social behaviour, bookies are an irresponsible industry, proliferating in our most deprived areas, sucking demand out of local economies and treating their staff with total contempt, many of whom have spoken to us in confidence but are frightened to speak out in case they lose their jobs.

Thirdly, there isn’t the infrastructure in place to deal with the number of problem gamblers we’re going to have if we keep seeing an incremental rise in the number of FOBTs. There won’t be a Prevalence Survey this year as the funding has been cut, but in 2010 there were 450,000 problem gamblers in the UK.

According to international evidence, each problem gambler costs the state £8,000 per year – yet the industry give £5m, just 0.1% of their £5bn profits – to the Responsible Gambling Trust, which funds one single NHS Clinic for Problem Gambling in the entire country. I spoke to someone recently who’d been on the waiting list for eight months.

For these reasons, this week we launched the “Stop the FOBTs” campaign in Westminster. Sign up, get involved, share your stories. If you know someone who has been affected by FOBTs, or if you have yourself, then we want to hear from you.

Despite stating that “common sense dictates there is a problem with FOBTs”, the government has said they will wait for the conclusion of research carried out by the Responsible Gambling Trust before it imposes any restrictions. But when the chair of the Responsible Gambling Trust is also the chair of the Association of British Bookmakers, is it surprising this issue has been kicked into the long grass until just before the election, when corporations start writing cheques to political parties?

We believe we can win by highlighting to MPs the extent of the problem, so find out how much is gambled in your constituency on our website, write to your MP, and join our campaign.

What does My Mad Fat Diary tell us about mental illness?

by Huma Munshi     February 13, 2013 at 9:25 am

To state that there is stigma and ignorance about mental health is an understatement. The media portrayal of mentally ill people is often in the context of extreme instances of violence and social disorder.

This continues to stigmatise mentally ill people and does nothing to raise awareness of their everyday struggles and the work they have undertaken to overcome moments of debilitating mental anguish. It also paints an unbalanced picture to the public. Disabled people are much more likely to be victims of hate crime, rather than being the perpetrators.

This week was a quietly successful day for campaigners that have advocated for this stigma to be challenged via a change in the law. The Mental Health (Discrimination) Bill 2012-13 was passed by both Houses of Parliament and now awaits Royal Assent to enable it to be passed onto the statute.

The aim of the Bill is to reduce the stigma and negative perceptions associated with mental illness. It would repeal legislative provisions that can prevent people with mental health conditions from serving as Members of Parliament, members of the devolved legislatures, jurors, or company directors. It says much about the attitudes towards those people experiencing mental illness that such a law is even required.

The evidence indicates that disability discrimination is rife. The Equality and Human Rights Commission investigation into disability hate crime states: “in the worst cases, [disabled] people were tortured, apparently just for fun. It’s as though the perpetrators didn’t think of their victims as human beings. It’s hard to see the difference between what they did, and baiting dogs.”

For people with mental illness the stigma of engaging in anti-social behaviour is a common one in the mainstream media. However, this representation is disproportionate and does not do anything to shed light on the extent to which mentally ill people experience hate crime themselves.

In its response to the EHRC consultation on disability harassment, the mental health charity Mind states: “since one in four people experience a mental health problem during their lifetime, and the vast majority of these people face crime and victimisation, clearly disability-related harassment is a significant problem for people with mental distress.”

In light of all this, and as someone who has personally experienced severe bouts of mental illness, it has been refreshing to watch My Big Fat Diary for people to get a real sense of what it is like to recover from a breakdown.

What I find particularly poignant is the struggle the lead character, Rae, has after her breakdown to rebuild her life and that desperate need we all have to lead a ‘normal’ life. This involves boyfriends and her navigating a complicated relationship with her mother. This is against a backdrop of flashbacks which triggered her mental anguish as well as the snatches of conversation we witness she has with her therapist. The latter is painfully accurate. The therapist gently pushes her to confront her past and that trigger situation which led to her hospitalisation.

I don’t recall watching such an accurate portrayal of mental illness before and I welcome it now in the hope that it raises awareness. I also hope that when the Mental Health (Discrimination) Bill becomes an Act of Parliament we can begin to engage in a more fair and open dialogue and process to ensure mentally ill people are not discriminated in public office.

However, remembering that one in four people will experience some form of mental illness in their lifetime, it is about time that we begin to properly support those people experiencing depression, anxiety and all the other multiple forms of mental illness that can be so truly debilitating.

Who wins and who loses under Dilnot’s social care proposals?

by Guest     February 11, 2013 at 2:42 pm

by Dr Emma Stone

A cap on care costs of £75,000 and a higher means-test threshold of £123,000 from 2017. What will this achieve?

At the moment, society offers little protection to those who face catastrophic costs of care.

Neither politicians nor the public are minded to pay for social care through greatly-increased general taxation which would make social care universally free at the point of access (on a par with the NHS). Yet the costs of social care are rising – both for the state and for individuals who need it.

The combined measures of raising the means-test threshold and setting a cap on the lifetime costs of substantial care, excluding board and lodging costs, at £75k (2017 prices) will give greater protection to the assets of older home-owners who face very high care costs and increase clarity and certainty about what they will have to pay for their own care.

Although many people will be in for a shock if they think the cap is equivalent to the total they will spend on care or support. It isn’t.

The Government also hopes – and needs – the cap to encourage those of us who can to start saving for potential care costs in later life, as we would for a pension. Hence the reference to the financial services industry.

Social care funding is not only about old age – it is about adults of all ages.

The proposals should give some peace of mind to some parents of disabled children who, on transition to adulthood, will have their eligible care costs paid for by the state.

But – and it is a big but – what is not yet clear, and will hopefully be part of the announcement, is how this will affect working-age adults who become disabled during adulthood. Given what we know about the links between disability, impairment, extra living costs, decreased earnings and savings potential, and unequal access to financial products – this is a key issue.

The recent report on The Other Care Crisis (by five leading charities representing disabled people) highlighted this well.

What we also urgently need to know is what the prospects are for a better settlement for local governments so they can fund adequate levels of social care – including, and most significantly, investing in prevention, early intervention and support for those whose needs fall short of the ever-increasing thresholds for eligibility for care and support.

When JRF responded to the Dilnot proposals back in 2011 – we said then, and we still say now, that a sustainable system of funding social care will not come about if there is insufficient encouragement to invest in prevention and ‘that bit of help’.

That message is everywhere in the draft social care bill – but nowhere in the proposals mentioned in the media yesterday.

So the cap and the threshold are welcome measures; and a welcome sign that the government is taking responsibility for addressing care funding. This is a start.

Cross-posted from the Joseph Rownstree Foundation

MPs are also partly to blame for the Mid-Staffs NHS scandal

by Guest     February 7, 2013 at 4:57 pm

by Claudia Tomlinson

When Julie Bailey, founder of Cure the NHS (@curetheNHS) campaign group, contacted her local MP about the horrors at Mid Staffordshire NHS trust, to her great anger, she was invited to a Labour Party meeting instead.

The MP for Stafford between 1997 and 2010 was David Kidney (@davidkidney), the crucial period when patients suffered so grievously. He had extensive knowledge of the hospital, and even worked there during the Parliamentary summer recess to better understand the environment.

Ms Bailey wrote to him detailing her suffering of her mother who died at the hospital during this period, only to receive a very complacent response. The Francis Inquiry report states about Ms Bailey:

She felt that Mr Kidney’s reply effectively denied the low standard of care evidenced by her and other constituents’ experiences at the hospital.

Kidney isn’t the only MP who came off poorly in the report, they were criticised for simply passing on complaints received from constituents back to the hospital. A year after she first made her complaint to Kidney, Ms Bailey and 30 members of her campaign group visited his surgery and individually described their awful experiences.

He responded by agreeing to arrange a meeting between the group and the hospital staff, the very organisation that had harmed them and their loved ones, then put up a wall of silence to their complaints.

MPs should have served their constituents better, and certainly not offered invitations to a party policy development group, at which their experiences would provide the Party with political leverage, but do nothing for patients and relatives. Ms Bailey was upset that her MP appeared to be using her suffering to further the work of his Party.

The inquiry report gently asks them to do better next time and deferentially asks them to consider developing systems to allow them to pick up on systematic organisational failure. Rightly, it acknowledges that MPs are not health regulators, but also point out they can be held to account by their electorate and should do better.

None of the local MPs, including David Kidney has been apportioned blame in the report, for after all, the damage was within hospital walls, but the report cites their parliamentary code of conduct for MPs:

Members have a general duty to act in the interests of the nation as a whole, and a special duty to their constituents.

There are clearly competing demands between the needs of the Party and the needs of constituents. This was a situation where the constituent’s needs should have been paramount.

Claudia Tomlinson tweets from here and blogs here.

British government to back health?

by Guest     February 1, 2013 at 6:35 pm

by Jenna Smith

The British government has backed national health via the NHS (National Health Service) since 1948 and continues to do so by creating television advertisements on prime time programs, advising the people of Britain to eat healthier. According to an article by the BBC, there is controversy on this advertising campaign, with some people pointing out that the main beneficiaries are in fact, commercial stores that offer the goods presented in the advertisement.

The commercial, part of the Change4Life campaign by the NHS to reduce the annual £5bn expense caused by obesity in the UK, shows characters made by Aardman (Creators of the Wallace and Gromit characters) changing their lifestyles in positive and healthier manners. Some critics are still sceptical that big time companies will merely use this as an excuse to exploit marketing of healthier foods in their favour.

Spending government funds for potentially, a commercial increase for privately owned businesses has raised questions as to whether the money should be spent on different projects to help the government. Potential draw backs of this campaign is that consumers may ignore it, and that stores will not participate in the scheme, as this is a voluntary set up.

This means that companies that would prefer to make a bigger profit margin with less healthy foods can continue the practice, and healthy food will in turn, be more expensive, as mentioned by Jeanette Longfield, a children’s food campaigner, “Good companies continue to do good things while bad companies continue doing bad things, and no one can stop them. What we really need is a legal level playing field so all companies have to do the right thing, for example, stop targeting children with marketing for junk food.”

However, overall, the positives are increasingly becoming a reality, over 1 million mothers have changed their lifestyle through the Change4Life scheme, which in turn has helped their children to live healthier.

This has also lead to an increase in consumer demand for health products, such as exercise equipment sold online at stores such as Fitness Superstore, or clothes that help our body function naturally in today’s world found at sites such as Rejuva Health. Companies such as these have increased their business in correlation with the Change4Life’s successful campaign.

So is the government backing the Change4Life scheme a good idea? Sure, it sinks in a lot of the taxpayers money, and there is no guarantee that it will work. However, something to remember is that this campaign will decrease the government funding in other areas, such as the NHS’ £5bn a year spent on helping people with obesity (by everette devan). Short term, this scheme will be risky for the government of the UK, however, the long term affects could easily over rule these early on possible drawbacks.

As Catherine Collins, principle dietician of St Georges hospital, London mentions, “As long as food manufacturers don’t exploit the ‘health halo’ effect of the targeted healthy products to encourage sales of less healthy foods and drink, it’s a win-win situation for both public and producers.”

Jenna is a freelance writer who most often writes about personal finance, business, and sometimes politics. She writes more at
Consideration was received for the editing and publishing of this article

Are we ready for bums on the breakfast table?

by Guest     January 30, 2013 at 4:51 pm

by Giselle Green

On this morning’s Today Programme menu was a discussion about cancer survival rates in Britain being worse than in comparable high income countries with similar health care systems. Research published in the British Journal of Cancer shows that we put off getting symptoms investigated because we don’t want to trouble our doctors as we’re worried about wasting their time or because we’re embarrassed about sharing our symptoms.

Interestingly the fear of a cancer diagnosis wasn’t a factor differentiating us from our international counterparts.

So why are we worrying about “wasting” our doctor’s time or embarrassing ourselves, especially when survival rates are hugely enhanced by early diagnosis? As Mark Flanagan of Beating Bowel Cancer told us, bowel cancel has a 93% survival rate if caught early enough.

Further research is being embarked upon but Dr Lindsay Forbes, the lead researcher in the report by London’s Kings’ College and University College, speculated that this delay in getting a diagnosis is due to the “British stiff upper lip”, that classic mix of stoicism and avoidance of discussing something embarrassing. (Another theory that the public is worried about draining NHS resources seems a little far-fetched to me. “Oh, I’m not going to get this lump checked out as I don’t want to use up my GP’s budget allocation” isn’t a phrase that I can imagine tripping off most people’s tongues.)

In a clear effort to desensitize the Today programme audience, Mark Flanagan of Beating Bowel Cancer seemed to relish talking about poo, bowels and bums. He even came up with the ultimate sound bite (don’t think too closely about that analogy): “We need to break the taboo; we need to talk more about bowels and bottoms, about blood and about poo. We need to get the message out that it’s ok to talk. “

Here, I thought, was the perfect clip for the BBC Radio 8 o’clock news to run. What a chance to break the taboo and get the message out to millions. But sadly not. A less arresting sound bite was chosen.

It seems poos and bums are fine for an interview, but not the news. We clearly still have some way to go in softening up that stiff British upper lip.

A grassroots campaign to drop the ‘schizophrenic’ label

by Guest     December 19, 2012 at 11:10 am

by Claudia Tomlison

The term ‘schizophrenia’ is frequently misused in conversation to indicate a divided opinion, or erroneously taken to mean ‘split personality’. E.g.: ‘I feel schizophrenic on that particular point’.

Frequently also, in the public mind it is associated with violence, threat and danger when the evidence is to the contrary.

The experts agree that this diagnosis means different things for different people and that it is poorly understood.

An independent inquiry into the use of schizophrenia as a diagnostic label is under way to investigate its validity, usefulness, and impact on the lives of those to whom it is applied.

The inquiry published its preliminary findings last week, with responses from approximately 500 people, using a range of research methods. Most respondents report that the diagnosis in itself has damaged their lives, impacting relationships, friendships and employment opportunities.

Males of African and Caribbean descent are over-represented in those diagnosed with this condition with little will on the part of the current government to investigate this. The last Labour Governments acknowledged and addressed this issue, which has now been abandoned by the Coalition Government.

The Schizophrenia Commission, led by Professor Sir Robin Murray, made headlines earlier this year when it described the poor care and experience faced by people given this diagnosis.

The independent inquiry into the schizophrenia label goes further and challenges the use of this damaging label when the scientific basis is so poorly understood and controversial.

It seeks to work in partnership with people who experience very individual real life problems, to co-produce meaningful ways of describing their problems, whilst retaining their humanity. The final report from the inquiry will be published early in 2013.

2012: how the NHS became privatised and the impact that has had

by Guest     December 18, 2012 at 10:23 am

by Alex Nunns

2012 will go down as a cataclysmic date in the history of the English health service. It was the year when the virus of privatisation finally gained control of the cell nucleus of the NHS and began its destruction in earnest.

If you listen to the politicians you wouldn’t know it. According to David Cameron, “we will not be selling off the NHS.” If you believe Nick Clegg, “there will be no privatisation.” They have been able to get away with this deception because the transformation they unleashed is messy. It is happening everywhere, but not uniformly. It is hidden by its very scale and spread.

But take a step back and the patterns are unmistakable. The controversial Health and Social Care Act passed in March 2012 ended the English National Health Service in all but name by abolishing the 60-year duty on the government to provide comprehensive healthcare for all. In its place is not so much a new structure as a process with its own dynamic-that of a snowball tumbling down a hillside.

All across the country treatments that patients used to receive are no longer available to them. Hip and knee replacements, tonsillectomies and cataract operations are among the procedures being restricted, forcing patients to wait longer, suffer in pain, or go private. Surgeries, wards, units and community services have been closed and clinical staff shed as the NHS desperately seeks to make “savings” of £20 billion.

Private GP surgeries near you
With perfect symmetry, the private sector expects to win £20 billion of business from the NHS, according to the corporate finance adviser Catalyst. Huge slices of the health service are being awarded to the highest bidder. With remarkable speed a few gluttonous companies: Virgin Care, Serco, Care UK – have secured dominant positions in the market, gobbling up services from Cornwall to Cumbria. The defenders of the reforms talk about competition driving improvements, but already it is consolidation, not competition, that we are seeing.

There may be a GP surgery near you that is now run by Virgin. Until March 2012 Virgin Care did not exist, although it had been operating under another name since 2010. It now runs at least 358 GP practices. Behind the friendly PR façade of the bearded entrepreneur, patients see a different face, cold and sinister. Take the Kings Heath Practice in Northampton. Since Virgin took it over from the NHS, patients have had to wait up to three weeks for an appointment instead of three days, three GPs have been reduced to one, and three nurses cut to one part-time nurse. And while the company boasts about the surgery’s opening hours, often there are no clinicians present, just an open empty building. Locals complain that Virgin has “brought Third World medical standards to Kings Heath.

Consolidation is also happening in out-of-hours GP cover. In November Care UK took over out-of-hours services for up to fifteen million people across England by simply buying Harmoni, a company that started as a GP co-operative. The only competition patients see is between their health needs and the profit margin. People in Cornwall know which wins out: an official report in July found the Serco-run out-of-hours service in the county was under-staffed and falsified data to meet targets.

The biggest privatisations are taking place in community health services. The government’s “any qualified provider” policy means whole services must be subject to competition, leading to the demise of NHS-run options. Local NHS bodies have already been instructed to outsource 39 types of service. Dubbed the “39 steps to privatisation,” this covers everything from autism care to wheelchair provision. Even publicly provided vasectomies are for the chop.

The ‘logic’ of privatisation
The logic of privatisation favours a few big winners over the co-ops, charities and social enterprises that act as window dressing for the policy. A prime example came on April Fools’ Day, 2012, when Virgin Care took over a £500 million contract to deliver community services in parts of Surrey. The joke was on Central Surrey Health, a “social enterprise” formed by former NHS staff that was praised by David Cameron and hailed as a model for the Big Society. Central Surrey Health scored the most points in the bidding process, but the contract was given to Virgin because of its financial backing.

Not even hospitals offer shelter from the destructive gale blowing through the NHS. Many Hospital Trusts are being pushed to the financial brink by the disastrous legacy of the Private Finance Initiative (PFI), under which new hospital building was financed by a deal that is akin to paying by credit card, leaving Trusts with crippling debts to the banks.

This has led to some Trusts literally going bankrupt, such as the South London Healthcare Trust which serves over a million people in three hospitals. Its PFI debts, like a black hole, have sucked in surrounding hospitals and units, like Lewisham’s A&E department which is now facing closure. Patients are left high and dry. As for the Trust, it is to be carved up and offered piece by piece for privatisation, with the familiar vultures-Virgin, Serco, Care UK and Circle-picking at the remains.

In a first for the private sector, in February 2012 Circle took over an entire general hospital at Hinchingbrooke in Cambridgeshire. The hospital has since fallen 19 places in the patient satisfaction rankings and its finances have worsened, forcing Circle to ask for a bailout after just six months.

Private income at NHS Hospitals
Combine this with another controversial aspect of the Health and Social Care Act-the ability for NHS hospitals to earn half their income from private patients-and the implications are scary. A chilling investigation by ITV’s Exposure program secretly filmed doctors assuring a private patient that her money would buy priority over NHS patients within the same hospital. It revealed a tragic case where a consultant left half way through a dangerous birth to carry out a private caesarean section. The baby later died. A two-tier health system is not on the way; it is already here.

The drive for profit is insatiable, not least because many of the dominant players in the new market are owned by ruthless private equity firms. Similar funding models to that which led to the collapse of the Southern Cross care-home company are now in the NHS. For example, Hospital Corporation of America, which is entering into joint ventures with NHS hospitals, is majority owned by three private equity firms including Mitt Romney’s notorious Bain Capital.

All of this comes before the most high-profile part of the Health and Social Care Act has even been fully implemented-the replacement of PCTs with Clinical Commissioning Groups (CCGs). Sold to the public as “giving power to GPs,” this transfers responsibility for spending £60 billion of public money to largely unaccountable new groups, who will in turn outsource the work to privatised “commissioning support units”-allowing the private sector to decide how taxpayers’ money is spent. If that sounds complicated, it is. David Nicholson, the head of the health service, fears it could end in “misery and failure.

The Labour party, after its record in government of opening the way for privatisation, has changed tack in opposition, repeatedly pledging to repeal the Act and scrap the market if elected. These are important commitments that it must be held to.

But the quantity of contracts currently being signed may take the NHS over a tipping point, where the “facts on the ground” cannot be reversed. That is why it is crucial to monitor, expose, slow and disrupt the destruction of the NHS now, while there may still be time to save it.

Alex Nunns is an NHS campaigner, writer and editor whose blog about a job offer from Care UK went viral in July 2011. This article was sponsored by the NHS Support Federation

How a subtle change in the NHS will turn patients into customers

by Guest     December 7, 2012 at 9:15 am

by Claudia Tomlinson

The Government is introducing a change to the NHS that seeks to turn hospital patients into customers by asking them to take a loyalty test from April next year. It is one of many new NHS schemes intended to groom patients to think of hospitals as businesses.

We are used to being asked for feedback after shopping, going to a restaurant, or using a call centre. From next April, if you attend an A&E department, or have an overnight stay in hospital this will also be your experience. Before you leave, you will find yourself shepherded to an electronic device such as a kiosk, or tablet to tap out your experience.

You might be given a questionnaire or feedback card to complete before signing out. Or shortly after leaving hospital, you will get a text message, telephone call at home, or receive a postcard or questionnaire at home asking you to register your opinion.

Everyone knows that things can go seriously wrong in hospital care of patients, and patients have to be given ways of making their experience known. It is right to keep an eye on what patients are experiencing. That can be achieved without introducing a system that will ask patients to demonstrate their loyalty to a particular hospital by recommending it to others.

This is quite different from recommending a restaurant. Hospitals will be forced to ask discharged patients whether they would recommend a particular ward or A&E department to friends or family, if they needed similar care or treatment.

Called the Friends and Family Test, it will be part of the NHS Contract which provides hospitals with their income so they could face financial penalties if they do not comply. Results of the test will be published nationally for all hospitals.

The Government has rushed to implement this under researched methodology, based on the Net Promoter Score developed by Frederick F. Reicheld (Harvard Business Review, 2003) as a technique to boost company growth by creating customer loyalty in business.

Simply, those customers who give high scores are ‘promoters’ who are likely to shop with the company again, and speak well about it to others. Those who give low scores are ‘detractors’ who will speak badly of the company to others, and are unlikely to return.

Then there are those in the middle, the ‘passives’ or ‘neutrals’ who are fairly satisfied with the service, but will probably go elsewhere if they find something better.

A pilot at NHS Midlands and East has been operating this year, and publishes the results on their website, listing providers in order of performance.

Do we really use hospital services in the same way as we choose mobile phones? Or is it as it looks, and the Government is taking another step in creating greater market awareness in patients, pushing us further along the road to treating the NHS as a business. Let us hope NHS loyalty cards are not looming.

Claudia Tomlinson is a London based public sector worker, researcher and writer, specialising in politics of health, inequalities, and internationalism. Views are her own

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