Friday, September 7, 2012

Why Inequality Matters

The Centre for Labour and Social Studies have produced a booklet 'Why Inequality Matters". This builds on the pioneering work of Wilkinson and Pickett in The Spirit Level.

As the booklet points out the case against inequality is not an abstract, moral argument. With an abundance of evidence, The Spirit Level dramatically revealed that it actually has an impact on people’s everyday lives. And as the Nobel Prize-winning economist Paul Krugman has shown, there is a link between inequality and financial crises. As he pointed out, it is no accident that both major modern crises – the first beginning in 1929, the second in 2008 – coincided with historic levels of inequality.

The chapter on health highlights that there are now over 200 studies of income inequality and health. Life expectancy, infant death rates, low birth weight, the number of people badly overweight, the number of people with poor mental health have repeatedly been shown to be worse in more unequal societies. The UK has the fourth lowest life expectancy out of the 23 most developed countries. The three countries that have even lower life expectancy are those with even greater income inequality – Portugal, the USA and Singapore.

Put simply, and that is this booklets strong point, inequality kills. That is why it should be central to our thinking on health policy in Scotland in the coming years.

Monday, September 3, 2012

Reform Scotland and GP services

Dave Watson on Reform Scotland's report on GP services.

I was intrigued by the Sunday media warm up to today's launch of Reform Scotland's latest report on GP services. GP's should have better web sites, well that's probably true, even if perhaps not the greatest challenge facing primary care at present. Even a suggestion that all GPs should be salaried. Dangerous socialist thinking here, straight from the SHA policy manual. Certainly not what we expect from the right wing marketeers at Reform Scotland.

However, I needn't have worried. The report itself is full of the predictable market led solutions that you would expect from Reform Scotland. An organisation whose objectives are the apparently,  traditional Scottish principles of limited government, diversity and personal responsibility". Translated this means- small state, privatisation and blame the poor!

The report's recommendations focus on extending GP catchment areas and allowing new GP practices to open. This will apparently create competition with better opening times and websites. And here was me thinking that patient care was the first concern of service users!

The wicked Scottish Government ban on commercial GP providers must of course be ended. After all are not GPs themselves private providers? Well yes they are, a hangover from the 1948 compromise, but that doesn't mean we make the position worse by importing rapacious privateers with profit as their only motive. I just wonder if Serco has made a donation to Reform? Not of course that Reform Scotland needs any encouragement to promote the influence of privatisation companies.

We can of course agree that GP practices should have a decent website and opening times could be more flexible. I don't in principle have a problem with a Scottish GP contract and I agree that health boards should be more democratically accountable. The SHA have strongly supported direct elections for this reason.

However, this report is very clearly focused on introducing a market approach to NHS Scotland on the Tory, English model. Planned services are the best approach to primary care provision, rather than wasteful competition that would lead to marketing managers replacing practice nurses. The relationship with a GP and their staff can be a very personal one and we dont want that compromised, any more than it already is, with the current commercial element. We have seen with privatised occupational health services the role commercial pressures can play.

SHA Scotland has long argued that we should indeed go in the opposite direction, through the introduction of salaried GPs. Many doctors working in primary care would welcome this as their focus, unlike Reform Scotland,  is on the patient not running a business.