Tuesday, 28 June 2011

NHS reforms: a pyrrhic victory?

So, government reform plans stymied. The smile wiped off Cameron’s face. Lansley humiliated. Been rather a good few weeks, hasn’t it?

Not so fast. A few thoughts, before we raise our glasses in unrestrained Schadenfreude, might give us pause.

What has certainly happened, over and above any disagreements we might have with them on policy, are two major errors: first, that the Tories foolishly bit off more than they could chew. They tried to completely restructure the largest employer in Europe with a rather hastily-put-together plan, whilst simultaneously trying to make real terms cuts. When what they really needed was an administrator of global stature – think the chief executive of a multinational, the former prime minister of a minor European state, or something similar – to plot out a gradual-but-radical approach to reform this huge, complex beast over a number of years. Instead they had the luckless Lansley, a career politician who enjoyed one brief period as a civil servant. In short, this job is not like restructuring the Passports Service (and look how difficult that turned out to be).

Their second error was political: they failed to win political support for their ambitious plans, with the public, their coalition partners and doctors. Most healthcare observers are aware that the latter, vital, vested interest has a history of not-very-helpful conservatism with a small “c”: Nye Bevan as Health Secretary under Attlee famously “stuffed their mouths with gold”, that is, bought them off with a sweetheart deal. Not to mention the public, who have a special fondness for the NHS which often borders on the sentimental, especially when the word “private” is mentioned in the same breath. No, none of these important constituencies bought into the plan, and the plan failed.

So where does that leave the NHS? With a revised plan, so lacking in any kind of meaningful change as to be worse than useless. Increased productivity through mixing public and private provision (not private funding: a vital distinction), which Labour first introduced in a modest way, which is practised widely on the Continent and which an LSE study has shown to save lives, has been all but removed. Also, bureaucracies have been removed in secondary care, but then others put in their place, which look worse. As the Economist succinctly puts it:
“…a fudge now may well lead to more dissatisfaction and shortfalls in the future. Meanwhile, the rejig has spawned new layers of bodies to ensure accountability. There will be “clinical networks”, “clinical senates” and a central, powerful commissioning body with local arms. So much for the bureaucratic cull Mr Lansley once promised.”
All in all, we are no nearer to giving patients the choice and standards of service required for a 21st century service. As my esteemed Uncut colleague Peter Watt – a former nurse – has pointed out, there are in any case still serious existing problems with standards of care in parts of our health service, a point the Economist concurs with:
“Scandals over the care of vulnerable patients and hospitals that fall below acceptable standards suggest the service is more prone to failure than its uncritical admirers admit.”
Whether or not you agree with all, any or no parts of the Tory reforms – and clearly there is a big debate to be had there – one thing is certain: the NHS for the next few years will function at best the same, and probably worse, than it has been doing to date.

But the real issue is that the NHS is crying out for reform, and any major reform is now surely off the agenda for either party until after 2015. Cameron surely will not attempt it without the mandate of a full majority, and neither will we. Meanwhile, the system will tread water, whilst all the time new and more demands will be made of it, as medical technology advances and, with it, public expectations.

So, we have rightly criticised the flawed reform program of the Tories, and perhaps helped bring it down, although we should perhaps modestly admit that the above-mentioned constituencies were probably much more important than us. And we have bought some time to develop the distinct policy of our own which is so far lacking, still pending the policy review. We have a political win: fair enough. We have done the best we could, from the constraints of opposition.

But, without trying to apportion blame in this complex picture, the judgement of whether no reform at all is better than a Tory reform is a finely-balanced one. There are real losers in this botched outcome of the reform plans: your family, and mine. Who will now wait at least four years for any meaningful reform to be started and, realistically, perhaps ten or more for it to be completed. Ten years more treading water, while we continue to lag behind other countries’ healthcare.

We all deserve better.


This post first at Labour Uncut

1 comment:

  1. This delay is indeed important to allow the topic to be considered properly, whilst I think to an extent that there are elements of social policy which need addressing, there is no need to rush into radical reforms for the sake of it. I wonder how these reforms as well as Obama's health are bill would impact upon international health insurance?

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