David Cameron claims to be the friend of the NHS. But the Conservative leader revealed his hand in last week’s health speech. His policy is naive and sinister.
David Cameron, the image-maker, claims to be the friend of the NHS. Yet Cameron the policy-maker revealed his hand in last week’s health speech. In several proposals a sense of naivety lingers:
Leaving the buying of all NHS services to GPs is a potential a recipe for chaos. As the small business people of the NHS, GPs do not feel obliged to take on tough decisions on where to deploy resources. GP commissioning is counter-cultural, not ideological.
Scrapping all targets is a throwback to the NHS of 1997, when a postcode lottery came as standard with GP fundholding. In those days there were no national standards for key diseases and waiting times were an embarassment. Targets underpinned Blair’s “funding for reform” deal for public services, and few NHS staff wish to return to older people spending 12 hours on A&E trolleys, a routine story in the 1990s. Other targets, for example for heart attacks, heart failure, cancer and stroke, though challenging have transformed patients’ lives through better outcomes.
Pay based on outcomes has already begun – NHS-wide hospitals’ incentive payments start in April for common conditions including cataracts and hip fractures. Improving outcomes is Labour’s unsung triumph, from the first NHS national standards across a range of diseases, to creating a clinical regulator and independent judge of new treatments in NICE.
More private providers of NHS services is the sinister bit. David Cameron said, “With a Conservative government any service provider from the private or voluntary sectors will be able to compete on equal terms for a NHS contract.” This is a throwback to Michael Howard’s “Patient Passport”, where patients choosing private sector treatment got 60 per cent of NHS costs towards their private bill. (In reality, Labour has only dabbled with private provision at the margins – a short-term capacity boost to reduce waiting lists).
So with commissioning given to GPs and “bureaucracy” decimated, who will hold them to account to create a seamless service for patients?
Cameron’s speech had minimal media scrutiny. As policy was it really naive, or a deliberate recipe combining small government and a large dash of market forces?
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7 Responses to “Cameron’s health policy: naive and sinister”
Jonathan Taylor
RT @leftfootfwd: Cameron's health policy – both naive and sinister http://bit.ly/rWiJj – agree, especially on scraping waiting times
joe fd
Yes a proper scrutiny of how free a free market policy tories are talking about is required. Would be good if professional associations broke silence on this, but everyone’s trying to cosy up to the tories! As I’ve said on this blog, the extent of/ approach to competition could be a dividing line. But labour should resist the temptation to go back on reform altogether. As burnham is (trying) to say, the nhs needs to use competition and choice pragmatically and cleverly to bring choice and innovation, rather than ideologically. But avoid being painted as roadblocks or look tired and out of ideas. Cheers, joe.
StopTheRight
RT @leftfootfwd Cameron's health policy – both naive and sinister http://bit.ly/rWiJj
Richard Blogger
There is another sinister aspect. Under the Tories profit in the private sector is inversely proportional to quality in the NHS. Lower quality in the NHS means more profits to the private sector. People go to the private sector for the “value-added” and the most important one is waiting time. If the NHS gives you a lengthy waiting time then one way to jump the queue is to go private. Remember that the expertise in the private sector is the same: you will be treated by the same consultant. (Indeed, since teaching is exclusively performed by the NHS you could even argue that the greater expertise is in the NHS.)
When Waiting list targets were introduced, waiting lists dropped. Consequently people could not get shorter waiting time by going private. When targets on quality (like infection rates) were introduced, the quality in the NHS rose and there was one less reason for people to go private. With the huge investments in new hospitals we have now got comfortable and clean treatment centres and wards another value-added that the private sector could not sell.
The problem as far as Cameron sees it, is that the NHS is too good. Even if we take into account the effect of the recession, the last few years have show a drop in people going for private treatment: they prefer to use the NHS. Fewer patients for the private sector means less profits. The NHS is just too successful. “Eccentric” Tories like Daniel Hannan even tell lies to try to denigrate the NHS (here is my response to some of the lies he was spreading) but we show that we don’t believe him by the sheer numbers using the NHS.
Currently the NHS uses the private sector to make up capacity. This has been very helpful in reducing waiting lists, and NHS patients benefit. In addition, there is a role for the private sector to provide extra capacity in day to day situations. For example, if there is an outbreak of nurovirus and NHS hospital wards are full of patients with this infection then the NHS hospital cannot perform routine elective surgery. In this case, the NHS can use the extra capacity in the private sector. This is the right thing to do because it puts the patient first.
But note that there are some important points in the last paragraph. If there is an outbreak of nurovirus in the community, where do the patients get treated? They do not get treated in the private hospital – the private sector does not have that responsibility – the NHS has no choice, it has a responsibility to the community. Further, where are clinical staff trained? It is in NHS hospitals. The private sector does not have that responsibility. These are *very* important points. They are points that everyone must understand. There is no level playing field in healthcare because the private sector can choose to turn its back on pandemics and training, and it does. So when Cameron says that the private sector should be “able to compete on equal terms for a NHS contract” he is hiding the fact that they will never be bidding on equal terms because they have fewer responsibilities than an NHS provider. The NHS always bids from a disadvantaged position because it has more (and costly) responsibilities than the private sector. The current situation (by and large) recognises that, and the private sector is used to get extra capacity, but it is NOT an equal partner.
The consequence of all of this, is that the private sector have moved from providers of choice to providers of additional capacity. That is important because as providers of additional capacity the private sector have to provide their services at NHS rates, and this drives down their profit potential. The private sector prefer to be the first choice of patients because in this case they can charge much higher rates. Targets have raised standards in the NHS and shifted private sector providers towards lower profit work. They don’t like this and I am sure Cameron knows this. This is one sinister reason why he wants to remove targets: they bring in greater scope for the private sector to make more profits.
It is worth pointing out that as standards have raised in the NHS the private sector have had to raise their standards to provide some “value-added”. So over all, targets have increased standards in the NHS and private sector. I should also point out that an NHS hospital, like any large organisation, will have internal quality control. NHS hospitals treat the national targets as *minimum standards* of care, internally they will have their own targets. So Cameron’s argument that abolishing targets will cut administration is nonsense because any reputable hospital will continue to monitor quality and will continue to strive to hit their own targets.
So Cameron wants to get back to the pre-1997 conditions. By abolishing targets he is implicitly indicating that he he does not want a minimum standard of care to be set. Lower standards are cheaper which gives scope for cuts. Lower standards also means that the private sector have a value-added to sell, it gives them more business and this means their profits rise. The Cameron healthcare plans are very sinister
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