Monday, April 04, 2011

Should we really be surprised that NHS reform has been botched?

I am not in the habit of saying, "I told you so", especially as there have been so many occasions when I didn't. However, I did take a look at Conservative health policy a year ago and noted the sea of contradictions that existed then. And, as far as I can tell, not much has changed.

This explains an awful lot, and is a precursor for future potential difficulties. You see, the Conservatives don't really get localism or at least, they don't really understand its implications. With localism, you get difference, not consistency, and you place your trust in local people. And that in turn means that they will make the choices that suit them. What is good for Barnsley may not work so well for Bury St Edmunds, and vice versa.

In an environment where politics is often about playing off one group against another, the dangers are obvious. If government devolves power to a community, and that community makes a choice that an opposition party doesn't like, who gets the blame? You can hardly blame the community, so you blame the government. The government, under fire from the media, starts to think about regulating for minimum standards. The more minimum standards are set, the less scope there is for the community to make choices, and before you know it, the benefits of localism are lost, and you've created another bureaucratic structure that is now purposeless.

The notion of localism underpins the 'Big Society' concept, but the desire to shrink the size of government is in stark contradiction to those Conservative strands of thinking that are paternalistic in nature or suspicious of empowering people that aren't like them. That isn't to say that all Conservatives are paternalistic, or that they distrust ordinary people per se, it's just that being socially conservative presents them collectively with a number of philosophical dilemmas.

The problem of creating a free market in healthcare overlooks a societal presumption that the NHS is the health provider of last resort. If the private sector cannot, or will not, provide a particular treatment, the public assume that the NHS will. This is not the basis of a free market. It must also be assumed that, in a free market, there will be a degree of surplus capacity, and in a sector where the element of choice is not so clear cut, who pays for that surplus capacity? Indeed, why should the private sector be expected to create it? No, far better to have the certainty of long-term contracts, which effectively limit the options of 'customers' (I'm sorry, I really hate the word, but 'patient' doesn't quite cut it).

Andrew Lansley's NHS reforms smack of a 'back of an envelope' calculation, and every retreat and every compromise simply demonstrates just how poorly thought out the original concept was. If the Coalition partners are going to emerge from the current cycle of budget cuts with any credibility intact, each of them is going to have to display a much more transparent and coherent approach to the changes that our economy and our country needs.

And whilst I still believe that the Liberal Democrats policies coming out of Government are fairly robust, the same cannot be said of the Conservatives...


Anonymous said...

if you really want to back up your argument about the Health Service and the present Government's Healthcare Reform plans (which is meant to read as NHS PRIVATISATION BY THE BACK DOOR, whilst the general public is asleep) then go and check out what is ACTUALLY happening in the sectors, or places where the Private "Partners" (in reality they are the owners as the money is made to pay their shareholders, not the taxpayers) have taken over the Services in the NHS. I speak as someone who lives it on a daily basis with first hand experience.

Mark Valladares said...


This is where I disagree with you. For policy to be successful, it needs to be built on solid philosophical foundations - I believe that the Lansley proposals are not. As a result, they are doomed to fail.

Governments of all stripes tend to see contracting out as a panacea when spending is to be cut. Theoretically, it can be, but only if the contract is tightly drawn and the consequentials factored in - very few public services operate in isolation. There is also the question of democratic accountability.

Liberal Democrats believe in devolution of decision making closer to communities, so that the idea of giving local people a say over what services are provided has some appeal. And again, the Lansley proposals are troubling in terms of lack of clarity.

It shouldn't be about public vs. private, it should be about how best the public are served. And that debate has to take place within a context where savings need to be found to pay for the increasing costs of care for the elderly.

And you, my friend, have a responsibility here too. Rather than simply telling me that private providers are bad in capital letters, which is a bit lazy, you need to make a case for how the NHS should be run, a case which takes into account the limits of available funding.