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Who can you trust to run the NHS?
Excerpt: This got missed a few days ago, but it appears that the answer to the question is "the Lib Dems", at least according to ICM's poll for The Guardian:
This got missed a few days ago, but it appears that the answer to the question is "the Lib Dems", at least according to ICM's poll for The Guardian:
And negative headlines about NHS deficits and job cuts have left Labour trailing the other parties on their traditional strength of health. Just 28% said Labour could be trusted to run the NHS, against 29% for the Tories and 30% for the Lib Dems.
What's remarkable about these numbers is that none of the parties emerge with an astoundingly high score. The Lib Dems are most trusted, but that still leaves a large number of people who don't think any party can run the NHS particularly well.
I think this cynicism reflects the mismanagement of the NHS by both the present and the previous government. Central government can't run the NHS well, and Labour's approach of trying to hire-and-fire local administrators on the basis of targets has been a failure. Whilst Blair promises perfection if he can just carry out one more reform, the public have become profoundly cynical about the whole matter.
Such centralised reforms are not the solution. It's wrong that if you have a problem with your local hospital, the first elected person who has any say in the matter is the Secretary of State for Health - responsible for the entire NHS (devolution provides Scotland and Wales with a slightly better ratio of people to power, but still not enough).
Looking back at the 2005 manifesto, I'm struck by how good some of the ideas sound. OK, "Lib Dem member likes Lib Dem policy" is hardly a story, but it's worth looking at some of these policy points:
- Scrap central government targets and the associated paperwork
- Abolish the quangos responsible for monitoring and inspection, merging their inspection role with existing social services inspectorates
- Move the healthcare commissioning role of Primary Care Trusts to local authorities
- Abolish Strategic Health Authorities, passing their commissioning role to local authorities or consortia of local authorities where necessary
- Plough the savings into frontline care
The movement of power away from the centre to local authorities is hugely important. Instead of a choice between "Labour spending and Tory cuts" as Blair and Brown would have it, there would be genuine local choice about how healthcare spending should be managed. Most importantly, local politicians live in the area, they have to use the local hospitals themselves and they are much easier to reach with criticism and feedback. The need for this becomes clear when you consider just how out of touch national ministers can become. Instead of an expensive and complex set of targets and quangos, voters would be able to express their view through the ballot box.
That such a bonfire of the bureaucrats would save considerable money - money that could ease or eliminate the deficits the current system has created - is a secondary benefit, but also a very important one. The fact that the NHS is sacking nurses because of deficits, whilst maintaining a vast bureaucracy, is a scandal. Moving the funds away from the needless target-setting and towards treatment-giving represents the best opportunity for the NHS to deliver better care.
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"Lib Dem member likes Lib Dem policy" is hardly a story
This rings a bell...
I agree that there are good proposals in the Manifesto. Personally I would like us to do more to show that we don't think public services should be run for the benefit of their employees (which is how dumping targets was played back to us).
Quite right Peter. I might even vote LD if I thought you were going to start running things for the benefit of consumers.
I think we would, your grace. But I think we need to make this clear.
I have blogged here on the NHS.
Are you linking to us? We will link back if you are....
Peter
http://liberalism2010.blogspot.com/
Has the media got it wrong over the NHS?
In the hunt for the NHS misspent millions the media blames the management or the politicians. Yet, these professional cynics are getting things wrong again in attributing blame. In fact even their solutions of giving power back to the nurses and doctors would make things worse for the NHS. It is simply ridiculous to suggest that the medical staff have the management skills needed to run an organisation which has an £87bn budget, has an economy equivalent to Austria, is the 33rst biggest economy in the world, and which employs over 1.3m people (as large as China’s armed forces).
There is also the media’s oft recited cry that the managers are not doing their job and that the private sector management would be more effective. Given the cost overruns and construction delays in projects like the Channel Tunnel, West Coast Main Line and the yet to be completed Wembley stadium, it is hard to take seriously this suggestion. Ironically, the business sector has often had to go to central government to bail it out their mistakes, often on a scale much larger than the relatively minor current deficit in the NHS.
Another criticism that the opponents of the NHS put forward is that government places undue emphasis on setting targets such as cutting waiting lists and hospital league tables. This is curious because it is difficult to identify any business organisation, even newspaper proprietors, which does not at the beginning of its financial year use a performance related targeting system. Any sensible business would set targets such as projected turnover, profitability, sales, productivity, market share, and of course, the directors and chairman performance bonuses! To suggest that an £87bn organisation like the NHS should not utilise normal business type techniques is verging on cloud cuckoo land. It’s curious that the media’s often quoted refrain that the Continent provided a higher standard of health care has become muted, now that the NHS has achieved its target of being one of the leading premier healthcare providers in Europe.
Finally, only a few years ago, there was the usual media clamour about the shortage of doctors, consultants and nursing staff. Remember all the stories about our doctors emigrating to the USA, because of the high remuneration etc? We don’t hear a word of it in today’s newspapers, do we? The position is reversed because now all the media bleats about is the NHS efforts in training has resulted in a surplus of medical professionals to come into existence. Admittedly some of this has been achieved by, as Bevan put it in 1948 “stuffing the mouths of doctors with gold.�
One final point can be addressed to the media, please stop making front page headlines about a drunken lout, that has to wait five minutes before getting treated in A&E on a Saturday night. The NHS is a massive organisation; even a private in the Chinese army may forget to make his bed!
Nicholas
You are correct that handing power to nurses and doctors is the wrong thing to do - they are clinicians and not managers. It is entirely spurious though to say that they are incapable of running an £87bn organisation. Nobody can run an £87bn organisation. Nobody. That's part of the problem. It's a commonplace now that the NHS is the world's third largest organisation after the Chinese army and the Indian Railways. Neither of these organisations are famed for their effectiveness either. We have to stop kidding ourselves that the NHS is the worst possible way of delivering healthcare. There is no other country in the developed world which has adopted such a ludicrous system. There are myriad ways of delivering universal healthcare and they are all of them better than the NHS.
At the end of the day, the state has shown itself incapable of running anything effectively. There should be a presumption that the private sector should deliver services. The state can then restrict itself to the more simple tasks of funding services for the poor, and perhaps dealing with catastrophic illness insurance.
Peter
Hmm...I used to have a feed of the blogs I read out of de.licio.us. It seems to be down.
I will fix it and make sure you are linked.
Bishop Hill
What you seem to forget is that the private sector is not very good at running such large organisations. As I said earlier 'There is also the media’s oft recited cry that the managers are not doing their job and that the private sector management would be more effective. Given the cost overruns and construction delays in projects like the Channel Tunnel, West Coast Main Line and the yet to be completed Wembley stadium, it is hard to take seriously this suggestion. Ironically, the business sector has often had to go to central government to bail it out their mistakes, often on a scale much larger than the relatively minor current deficit in the NHS'.
No the only sensible course of action is not to be driven by ideology. as with most situations, it depends. Sometimes it is better for the private sector to lead and at other times the public sector is more appropriate. Sometimes it is better a mix. Deciding on the most appropriate mix is the real challenge when tackling the problems faced.
After all the state proved very effective in defending this country during the Second World War. Also the NHS is an overall success story, that we should be proud of. Managing change is always difficult. Even the American's find letting the private sector have such a dominant lead has its problems, with its higher unit costs and a high proportion of its population not covered by any form of health insurance. Even in the UK - when things go wrong for private sector patients - often or not private sector patients have to be transferred to the NHS for treatment.
As for the refernce to the China - I meant the front line staff only.