Granny Smith

There was a time when if you were a passenger on a train you were referred to as a passenger. Now, of course, you are a customer. Managers think this change is important. As a passenger Dr Grumble finds it irritating. It gives him the impression that the railway now just wants to profit from him and not look after him as he tries to get from A to B.

There are those in the hospital, not usually doctors, who insist on calling their patients clients. The implication is that there is something demeaning about being a patient. Dr Grumble is a patient like everyone else. He doesn't feel demeaned by being a patient. Dr Grumble happily refers to his GP as his doctor and Dr Grumble sees himself as one of his patients. He is certainly not a customer nor does he want to be.

In a heavily veiled sort of way this is all about money. Passengers are people who go from A to B. Customers are people from whom you extract money. The managers want the staff to focus on where the money comes from rather than getting people from A to B. Big Business is interested in the corporate customer. BA is interested in Dr Grumble the business traveller but not Dr Grumble the cheapskate tripper.

You can see the same changing focus in healthcare. The people who are sick are the poor and the elderly. They make needy patients but are not ideal customers. Yet NHS provision is moving more towards the needs of the city slicker and the worried well. These people are customers rather than patients. They are vocal. They have power. Their money speaks. Polyclinics for healthy patients with money are attractive for Big Business. They will be easy to privatise. And privatised they should be because the taxpayer should not be paying to meet the needs of the wealthy worried well. It's the impoverished chronic sick that need the NHS and the taxpayer's support.

Contrary to what the vocal worried well believe, the concerns of GPs about the change to Martini healthcare were nothing to do with restrictive practices. Their concern was for Granny Smith. It was to do with their realisation that in today's NHS Granny Smith doesn't seem to matter any more.