It's an irony of British politics that the NHS has killed off more than one political career. It is a unique system, a system which no doubt has its failings. A system that wouldn’t, and perhaps couldn’t be created from scratch in the early 21st century.
Too expensive, they would say. Too inefficient. Too bureaucratic. A mug-of-tea socialist solution for a cappucino capitalist age.
But the British people love the NHS. Come election time, it has always been – and will be again – one of the first things people think about when they put their cross in a box. Meddle with it at your peril.
And then there’s a further paradox. Politically, the NHS is untouchable. Economically, though, the status quo is increasingly unsustainable.
Medicine gets more expensive, and the more successful we are at keeping people alive, the larger the elderly population – who tend to require disproportionately expensive medical care.
Politicians are acutely aware of both these truths. David Cameron was at pains to say during the general election that the NHS would be protected from direct cuts to its budgets, while other departments suffered. He has been true to his word.
No doubt it was something he did out of principle. But he also knew how important his pledge to protect the NHS was in detoxifying the Tory brand.
Similarly, Tony Blair was as keen as the coalition government to introduce more competition into the NHS, in order to drive costs down and quality up. Only last summer, the former prime minister seemed to stamp his approval on the principle – if not the detail – of Andrew Lansley’s attempts to shake-up the health service.
"[We started] some of the technical aspects of reform," he said. "You start something, and if the idea works and is a good idea and people take it forward, that is great."
The challenge, then, is to come up with reforms that will achieve real change without unpicking the essence of the NHS – the things that voters value most.
It is here the coalition seem to be failing – and failing badly. Representatives of the medical profession are increasingly at one in their opposition to Mr Lansley’s plans – even those who would be handed the purse strings as a result. Worse, a poll this week found 62 per cent of the public no longer trust ministers on NHS reforms.
Some worry about the idea of putting medics in control of money when they should be concentrating on making people better.
Far more, though, are worried about the greater involvement of private companies. It isn’t just the left that is feeling distinctly queasy about the idea that firms could undercut NHS providers on cost, potentially even forcing them to close.
Mr Lansley points out that public money will still be being spent providing a public service, free at the point of use.
But the fact remains: this is one area where the British public, as a whole, is unconvinced that old-fashioned capitalist competition will drive up standards.
It isn’t just Mr Lansley who is getting battered by all this – however much certain Liberal Democrats, and perhaps even some Tories, might wish it to be so.
By defending his health secretary to the hilt, Mr Cameron is putting himself firmly in the firing line. Then – just a day after deputy Lib Dem leader Simon Hughes suggested Mr Lansley should ‘move on’ once his bill becomes law – his boss Nick Clegg said Mr Lansley was ‘the right man for the job’.
Mr Lansley may have been the one who split the ice, but the cracks are spreading out beneath everyone in the coalition.
It is a bizarre and potentially damaging state of affairs for both parties – and the Lib Dems, perhaps, in particular.
Having worked hard to reposition themselves as ‘critical friends’ of the Conservatives, we now have a situation where Mr Cameron and Mr Clegg stand on one side of a political divide, and Mr Hughes – not to mention 13 Lib Dems who are publicly calling for the release of a ‘risk register’, compiled by Department of Health official and containing a list of potentially-explosive pitfalls of the reforms – on the other.
Mr Clegg would no doubt say he is doing the right thing – being true to his own principles as well as the demands of collective responsibility. Voters, more confused than ever about who stands for what, won’t necessarily thank him for that.
Mr Cameron, too, now finds himself in an almost impossible dilemma.
Plough on, and risk alienating the medical professionals as well as voters still further on what will be a key election background. Not only that, but give ammunition to a woefully under-equipped opposition. Or water down the reforms, and abandon what is the coalition’s highest-profile domestic policy to date.
Admit, in short, that on such a vital issue, the government has got it wrong.
More likely, then, that the coalition will muddle through with a few minor tweaks to try, and no doubt fail, to placate the critics. A sticking plaster, if you like, over a gaping, growing wound that is in grave danger of becoming septic very soon.
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I think the original idea was sound. Unfortunately because advancement in health and wealth fare funding, the service is bursting at the seams to cope. For instance do you need a Television cum Phone for every patient. Computer for nurses. Also there is no comebacks on wasted funding with these and PFIs. Lets not forget the old bugbear "Free For All". Newcomers into the country must contribute until eligible for NI card, this makes a mockery of someone waiting for operations as a longtime payer only to be queue jumped.
The NHS is not perfect, but neither is it as sick as the coalition and the vested interests would have you believe. Unfortunately, all politicians like to 'make their mark' and so despite campaigning on a promise of no top-down reorganisations of the NHS, the Tories, drunk with power after so long in opposition just couldn't help themselves and rushed out a half-baked reorganisation designed to, and I mean deliberately designed to, fill the pockets of the GPs who would hold the budgets, and their private sector providers who would pick off the NHS 'profitable' services one by one. Have you, has anyone, seen a business case for the reform with clear measures of benefit and costs? No, thought not, me neither.
Why aren't the Foundation Trusts against it? Because their consultants have been bought off by promises of increased income from private work in NHS premises - the previous cap to ensure continuity of NHS provision is now under threat was 'buried in the news' just before Christmas. And FT Boards are now stuffed with private sector non-execs, many former partners and senior managers from the Big4 accountancy and consultancy firms, whose pensions are dependent on the continued success of these firms. The same firms are increasingly employed as consultants, and auditors in the NHS, Monitor and even local health bodies, so their focus is on making money from the changes, not the value of the changes. Everyone is happy to look the other way as their pockets are being lined, and or their egos massaged by the new powers they will have.
Where it is starting to unravel for the coalition is that more people have taken an interest in it than they planned for, and these people haven't been fobbed off by the fatuous and condescending answers they have been given - for instance, the government are still insisting this is not a top down reform! Do they think we're stupid?!
But, the government has been forced to introduce some element of governance into the reforms - they thought we would all trust the doctors to do the right thing, and ignore their own interests when commissioning care, And these brakes on the powers, and the sheer workload involved means that GPs won't simply be throwing money around like sweeties, they will have to account for it, and more importantly, will have to ration healthcare, and face the patients and take the blame when services are not available. And instead of simplifying the process, the myriad of new organisations will actually make things worse, but by the time this madness is worked through, there will be no-one with any experience left in the NHS to sort it out because they will have been paid off in ill-conceived voluntary redundancy schemes that see replacement staff appointed before the cheque has even cleared. So the management consultants will come in again, and sell another half baked reorganisation.
If, sorry when there are no improvements in the service, and productivity falls, and (please God) this unprinciple shower of a Government are run out of office, it all starts again with a different set of self aggrandising, eyes-on-their-place-in-history politicians and their friends in management consultancy. The irony is just what all of this is doing to my blood pressure - and the fact I will need a doctor soon.
Comparison studies also show it to be one of the most cost-effective healthcare systems in the world. So, not really a major argument for introducing competition. The US system has much more competition, costs twice as much, is far more unequal, and yet British people still live two years longer than Americans.
An interesting article David. You're basically saying the NHS needs reform, the public and health professionals don't like what's proposed, so the Coalition are probably going to water down the bill to assuage opposition ending with a reform nobody wants or needs.
I totally agree the NHS needs reforming, however, I'm not so sure the health lobby can be trusted to know what structural reforms represent the best outcome for the public (I choose my words carefully - the "health lobby" is a different beast to most health professionals, many of whom welcome the chance for having a greater say over strategic decision making). As a friend wrote to me the other day:
"I don't trust doctors and nurses to tell me about structural reform. There are two main reasons - firstly, it's perfectly obvious that they are not independent. Indeed, the groups which have expressed opposition are mostly established lobbying groups.
Secondly, according to representatives of the medical profession, the National Insurance Act 1911 was the end of British medicine. They also opposed the establishment of the NHS itself - Bevan admitted that he only got it through because he "stuffed their mouths with gold". I am therefore deeply sceptical when they now expect me to believe that there really is a wolf about to rip out the throat of British medicine. Their track record is one of conservatism, not enlightened engagement."
You have cited a consensus (Blair) over greater competition, but the insertion of greater privatisation as a cause for concern. Whilst I agree that limited competition within the NHS can and does lead to a more efficient and productive service, I don't believe the proposal to give Monitor, the NHS trust regulator, the duty to promote competition was very sensible. The key regulator in an integrated service such as the NHS, should be to promote and protect the interests of the patient, rather than to promote the interests of accountants.
The Lib-Dems recognised this and passed a spring conference motion last year that called on the Government to amend the bill to provide for:
"An NHS, responsive to patients’ needs, based on co-operation rather than competition, and which promotes quality and equity not the market."
(http://www.libdems.org.uk/siteFiles/resources/PDF/2011%20March%20Sheffield%20Report.pdf)
It was this motion that led to the "pause" in the bill for several months last summer whilst changes were made. Clegg himself was very public with his criticisms of the bill (http://www.bbc.co.uk/news/uk-politics-13435223) and a month later it was then announced that Monitor would indeed be stripped of it's duty to promote competition (http://www.gponline.com/News/article/1075032/Monitor-stripped-power-promote-competition/).
The Lib-Dems ensured the bill was re-written to ensure that no back-door privatisation of the NHS could occur. To say we are on the opposite side of public opinion, does not reflect the the significant changes we have made to the bill, which I believe are more in tune with public opinion.
However, I totally agree that the presentation of this bill has been handled badly. Ask most people what the essence of the bill is, what the principle reforms hope to achieve, and you'd probably get responses ranging from complete ignorance to angry accusations that it's a capitalist plot to privatise the NHS. Hardly any non-political friends I know has an even moderate grasp of the aims of the reforms, and who could blame them? The government simply hasn't sold these reforms well enough to the public at large, and has instead wasted too much time concentrating on the health lobby that has flip-flopped it's support and opposition over time.
Nevertheless watering down the bill, or worse abandoning the bill altogether due to public ignorance and misplaced concerns or professional intransigence and producer self-interest would be entirely self destructive.
I'm pleased that Cameron and Clegg have shown a united front over the amended reforms and that they appear, for now, to have the steel to see them through. For the coalition to walk away from these badly needed reforms would be political cowardice, and would harm public confidence in the government to see through it's subsidiarity agenda of public services.
i take offence at you describing older people as an expence remember they have paid for thier medicines in a life time ,,, so its paid for , everything has to come down to the expence just close a few theatres cut the arts council budget and raid the lottery profits ..simple .ooooh yes and the bankers bonuses put them in the pot .