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September 22, 2006
Polly on the NHS
Well, if you say so Pollyanna:
No problem either in stirring up local Tories and Lib Dems, with newspaper campaigns to fire up every citizen in the town. The protesting consultant who intends to stand for parliament in Bedford may be only the first of a new wave. Labour MPs will join the scrum to save their seats. In Stockton, Middlesbrough and Hartlepool they are locked in public combat over which of them loses a maternity unit.
No wonder every previous government chickened out. Closures may be the right thing - but perhaps not now, when they will be portrayed as "cuts" to meet Labour's deficits. Indeed they are partly to save wasted money. Good arguments and specious arguments will blend into one story: "Labour cuts risk lives to save cash".
This is, of course, inevitable. If you have a medical system entirely controlled by the political process then people will use the political process to get what they want out of it. While the NHS is run, in mind numbing detail, from the centre by elected politicians then people will vote on the basis, and politicians will fight over, said system. You can't take the politics out of it until you take the politicians out of it.
Now add that beating heart of Labour's reforms - payment by results, the full-throttle market, only beginning to bite. (No other country anywhere has introduced such a ferocious market, let alone so fast and all at once.)
There's a very good reason for that. Now, what was it?
The NHS could lose Labour the next election; that would let NHS predators claim that the whole universal free system is "unfit for purpose". A rising noise on the right, much encouraged by the rightwing press, calls for the introduction of insurance-based schemes. Every time the NHS stumbles they crow at this "proof" that a free, tax-based system can't survive.
Ahh, that's right. No one else has ever actually copied our insane system of 1.2 million people run by a Stalinist bureaucracy. Where health care is indeed entirely state funded it is devolved downwards to smaller organisations. Like the counties in Sweden.
And do you know what? The health system that the international statistics show is the best one, the French, is based on insurance. Perhaps, just maybe, the righties are right? That tax-based free at the point of use (for of course tax-based is not 'free' in the idiotic way that Polly describes it above) is not actually the best way in the world to run a system, certainly not if you're going to try and do it with rigid central control of 1.2 million people?
September 22, 2006 in Health Care | Permalink
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Comments
"Good arguments and specious arguments will blend into one story: "Labour cuts risk lives to save cash"."
Heaven forfend that Polly should encounter such a dreadful display of poor journalism. When Labour is in charge...
I fear we all need to bookmark this quote for safekeeping when Labour is kicked out in a few years time...
Posted by: The Pedant-General | Sep 22, 2006 9:16:39 AM
It's the persistent lying and manipulation by this government which get me most of all but then we have known that for years. As Philip Stephens wrote in the Financial Times on 28 April 2000: "Mr Blair is manipulative, he is obsessed with presentation, he stifles legitimate dissent."
And they call it "democratic". How well I remember it - the day before the general election in 1997 which brought Tony Blair to power, New Labour was pumping out on the airwaves and in text messages: "Only 24 hours to save the NHS".
New Labour didn't mention then that nine years on, the New Labour government would be proposing to close up to 60 Accident and Emergency departments in hospitals around the country just a few months after Patricia Hewitt, the Secretary of State for Health, had declared: "the NHS is enjoying 'its best year ever'"
http://news.bbc.co.uk/1/hi/health/4935358.stm
Pardon me, I forgot. The terminology "hospital closures" and the like has been bannished from government speak.
In the official Orwellian Newspeak, we now have instead: "reconfigurations of the NHS."
Posted by: Bob B | Sep 22, 2006 9:48:45 AM
In the late eighties it was true (IIRC) that the NHS had had a bigger budget, in real terms, every year since it was founded, save for a spell under the late 70s Labour government. Is that still the case?
(Implying, inter alia, that the Thatcher Cuts were a fiction that, presumably, Polly propagated enthusiastically).
Posted by: dearieme | Sep 22, 2006 11:57:31 AM
The economy has done better since the Chancellor got rid of the power to set interest rates. In the same way if hospital regions were made fully independent with a set budget per person (probably with a bonus for elederly, possible a bonus for rural areas) then they could get on with it.
Having the power of patronage over hospital services is a 2 edged sword for politicians because they can never provide as much patronage as people want.
Posted by: Neil Craig | Sep 22, 2006 1:14:07 PM
So, that would be the French system with a deficit running into billions of euros then?
Posted by: ?Worstall? | Sep 22, 2006 1:40:06 PM
I take it that Polly means 'unfit for its intended purpose'. Unfit for purpose is meaningless jargon.
Posted by: pete | Sep 22, 2006 2:11:43 PM
Bob B says "How well I remember it - the day before the general election in 1997 which brought Tony Blair to power"
I remember too Bob. You were claiming then that Ken Livingstone would pull a coup and become PM the way he became leader of the GLC.
How did that work out?
Posted by: dave heasman | Sep 22, 2006 5:36:59 PM
Hi Dave: "You were claiming then that Ken Livingstone would pull a coup and become PM the way he became leader of the GLC."
News to me and doubtless you will probably also want to remind me of my dark forebodings about Britain joining the Euro in our debates online ten years ago but to alleviate any disappointment for the present, try this instead on the recent topical announcement about the prospective closure of the A&E Department at Burnley General Hospital:
"BLACKBURN MP Jack Straw has been branded a 'fool' for his attempts to defend the loss of accident and emergency services at Burnley General Hospital. Mr Straw tried to allay fears over the loss of the Burnley hospital's ability to handle major A&E cases by saying it only took 10 minutes to travel between the two towns.
"However according to the AA's route finder it would take double that time to get from the Casterton Avenue site in Burnley to the Royal Blackburn Hospital. And to get there in 10 minutes motorists would have to travel at a constant speed of around 80mph!"
http://www.thisislancashire.co.uk/news/localnews/display.var.917211.0.mp_branded_a_fool_over_10minute_journey_claim.php
However, to recap on Ken Livingstone and political debate: "Tony Blair today called on Ken Livingstone to apologise for likening a Jewish reporter to a concentration camp guard, intervening in the row for the first time and piling further pressure on the mayor of London."
http://society.guardian.co.uk/governinglondon/story/0,,1415725,00.html
Posted by: Bob B | Sep 22, 2006 8:51:42 PM
Neil - On the notion attributed to GB in the news of setting up an independant board to run the NHS, this by Professor Julian Le Grand at the LSE is worth reading:
http://news.bbc.co.uk/1/hi/health/5373096.stm
It makes most of the worthy points but I can't resist a feeling that the main motive driving the proposal is to insulate ministers and the government from contentious and unpopular healthcare decisions. My objection to both the proposal and Le Grand's comment is that the proposal is about political and administrative structures, not about the fundamentals of whether we want to retain a system for healthcare that is the "largest single employer in all Europe" or reforming the working of NHS.
In his interview on the BBCR4 Today prog, Le Grand made the important point that running the NHS by an independant board would transform the management structure of the NHS into the kind of structure that used to run the nationalised industries. I'm saying here that as we came to learn about the nationalised industries to our cost, that management structure became very adept at entrenching and serving producer interests but insensitive to consumer interests.
In various websites it has been suggested that something like 70% of the extra government funding for the NHS and more has been absorbed in higher salaries, mostly centrally negotiated - doctors salaries in the NHS have just risen year on year by over 20%.
As Patricia Hewitt has just said: "Despite the extra cash put into the system, productivity had remained 'almost unmoved'":
http://www.timesonline.co.uk/article/0,,2-2364557,00.html
How sure can we be that a new management structure for the NHS will resolve the challenge of increasing both NHS productivity and outturns. From what I've been reading, the NHS does not show up too favourably when comparing its outturns with those in other west European countries - notably on longevity, infant mortality, and sucees rates of standard surgical treatments.
Posted by: Bob B | Sep 23, 2006 11:17:25 AM
