Tuesday, 5 April 2011

NHS Reform: They're going to blow it, aren't they?

Attack him where he is unprepared, appear where you are not expected. Sun Tzu
Amongst most of the rubbish of the current Conservative government (little change from Labour except some miniscule "cuts" which are really just waiting a decade for inflation to catch up), there was one genuine ray of hope: NHS Reform.

It was a ray of hope from 2 perspectives. Firstly, I have serious, personal problems with the NHS. It is, like most agents of the state, a bad servant. It has no contract with you, and little source of redress. You take what it offers you, and you'll like it. This has resulted in me personally having to resort to Google to diagnose a serious illness because the GPs I saw barely gave a shit. They didn't treat me constantly coming back with a problem in the manner that a private sector provider would, of escalating the issue.

Secondly, I believe that we need people to see that the best model is often public funding with private provision. Once done with the NHS, we could say "look at how much better the NHS was after we reformed it, now, what's the argument against doing the same for schools?". We know it works because we already do the same thing with food for the poor, prescriptions and NHS spectacles.

I really thought it was going to happen because Lansley had caught the socialists and producers off-guard. The Conservatives had promised to protect NHS spending which meant that no-one had looked too closely at the manifesto. I figured that by the time they would be able to organise themselves against it, we'd have lots of private options and they'd be working for hospitals where they'd be expected to deliver for patients and get a ticking off if they got a bit lippy.

Sadly, Dorrell's stupid intervention is likely to kill it. Putting hospital clinicians, public health experts, councils and nurses on the commissioning boards is simply going to lead to them protecting their own, which is existing NHS hospitals. They'll wreck public choice by loading it up with so much bureaucracy that there will be little room for innovation. At worst, Lansley now has to pause, giving the producers the opportunity to regroup, mount a new defence and put enough spanners in the works of reform that it won't go far enough.

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