By Dr Michael FitzpatrickA glass of stout, a puff on a pipe, a session at the bingo or a flutter on the ponies - these are some of the simple pleasures that have sustained the well-being of generations. Yet, though the government is now committed to improving the well-being, as well as the health of the people, citizens will be banned from spending any of their "personal health budgets" on these life-enhancing activities.
There is no specific guidance on the controversial question of whether they are allowed to commission the services of sex workers but, as "anything that is illegal" is out, these budgets will not support the sort of puffing that many of my patients with chronic conditions find beneficial.
Personal health budgets, which are currently being piloted, are already floundering in the chaos resulting from the abolition of primary care trusts (which are supposed to administer them) and the wider climate of public sector austerity.
Yet they reveal a profound lack of confidence at the heart of the government's health service reforms. Contrary to the notion of politicians driven by ideological zeal for privatisation, plans for personal budgets reveal that the government neither trusts individuals to pursue their own interests in the sphere of health, nor expects market forces to meet their needs.
Rather than putting power in the hands of patients, these half-cock privatisation proposals are destined to create new layers of bureaucracy. In parallel with trends in social care, they will generate a new cadre of public sector professionals - advocates and brokers - to draw up and administer budget plans.
The supreme irony of the personal health budget pilots is that they exclude GP services, surely for most people the most important sphere of personal health expenditure. But if the government has such faith in the market, why should patients' relationships with GPs be excluded from its choice-promoting, well-being enhancing, therapeutic powers?
Dr Michael Fitzpatrick is a GP in Hackney, London
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