The NHS is wounded by internal market and inspection culture | Letters

Here is an alternative our chronic impasse over the NHS (Report, 17 February): abolish the internal market, together with its draconian micromanagement and inspection culture. These are flawed and failed ideologies. In attempting to replace vocational motivation with commercial incentives we have all but destroyed the best of healthcare’s professional art, heart, spirit and intellect. Our profession’s impoverishment of morale is widespread and increasingly hazardous. The internal market is inviably complex and divisive. It has undone collegial trust and therapeutic networking, and has replaced these with dense, rigid institutional procedures and documents that are often known to be senseless, often corrupting. Increasingly I have witnessed just-legal feints and “creative accountancy” to deceive yet formally comply: redesignations to double-count, cherry-picking referrals for financial or statistical advantage, for example.

Our earlier, pre-marketised system worked much better. Older practitioners know this well; many patients sense it, often without fuller understanding. The government’s position is nervously defensive; the opposition is now too disarrayed to marshal the formidable counterculture to rid ourselves of this tumourous burden. The longer we leave it, the worse it will get.
Dr David Zigmond (GP)
London

• It is unfortunate that you didn’t reference the important role that health visitors play and how they are currently being cut in many areas across England (Report, 15 February). The coalition government correctly addressed the need to increase health visitor numbers in 2011, but since 2015 NHS statistics show their number is decreasing, caused by the scandalous cuts to public health budgets which are totally counterproductive to both improving the nation’s health and the cost-effectiveness of services. The government, and the prime minister herself, talks about the key importance of early support but the reality of their policies totally undermines this rhetoric.
David Munday (health visitor)
Stalybridge, Greater Manchester

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