David Cameron has come out fighting in defence of his proclaimed once-in-a-lifetime opportunity to push through radical health service reform. The prime minister claims to have grasped the mantle of Blairite public service reform, but just how true is this? Repeating the mantra of choice does not an heir make, and on closer examination the Tories’ proposed reforms are anything but Blairite.
The thrust of NHS reform since 1997 was focused on leveraging competition and choice to raise standards by nudging patients towards better facilities, thus creating an obvious incentive for other providers to improve quality, the end result being rising standards for all. Faced with a choice in provider, the average patient turns to their GP for advice, who currently can make recommendations free of cost considerations.
The Tory proposal to hand commissioning responsibility to GPs immediately creates a conflict between the interests of the individual patient and the GP consortium. With GP consortia agreeing bulk commissioning deals with set providers, doctors will be faced with the inevitable pressure to direct patients based on a financial, not patient-focused, imperative. Indeed, the increase in competition through GP commissioning may well lead to lower costs, but it does not follow that quality of care will increase. This producer-led healthcare model is far from the patient-centred vision of the New Labour reformers.
The proposed reforms signal a massively increased role for the private sector in treating NHS patients. Tony Blair and his advisers were keen to invite private providers into the NHS, not just to encourage a focus on improving quality, but to provide extra capacity within the NHS at a time when it was greatly needed. The private sector therefore complemented mainstream NHS provision, rather than competing with it directly. The Tory plans, however, envisage a situation where EU competition law is applied to allow for-profit providers to compete head-to-head with NHS providers for the commissioning contracts. One could argue the reforms are designed as a Trojan horse to bring the NHS into the ambit of EU competition law and effectively allow privatisation of the NHS – the dream of many Tories and Orange Book Liberal Democrats.
Ultimately, the proposed NHS reforms are expensive, ill-considered and unsupported by those who are treated in, and work for, our health service. At a time when £20 billion is to be cut from the NHS budget, the Tories are gambling on reforms that will cost in excess of 10 per cent of the cuts sought – resources better spent on treating patients. Labour health reforms took place at a more considered pace in a climate of economic growth. Where Labour reform was facilitated by a real-terms doubling of NHS funding under Blair, Cameron is seeking to achieve radical reform to the backdrop of drastic reduction in government spending. The result will be a loss of capacity, an increase in waiting times and poorer healthcare outcomes.
Just as in 1997, it looks like Labour once again will rise to the time-honoured challenge of rescuing our National Health Service from the grasping fingers of Tory destruction and privatisation. Cameron’s claim to be ‘the heir to Blair’ has never sounded so far-fetched.
Well yes and then again maybe not. But I suspect when and if labour gets elected again they will change very little. As you say this is not labours plan but I suspect it will be, we all know Labour brought in a lot of changes to Welfare, stopped income support and loved to see Thatcher at number 10. I’m pretty laid back now with the Tories because I now know if Labour was in power they do the same, almost anyway. labour Tory, Tory labour the difference is so slight it makes hardly any difference, I think labour will find the people are willing to accept the Tories now, because it’s the same as New labour.
Sadly New Labour did start all this, and organisations like Progress – who supported this route – should hang their heads in shame. “leveraging competition and choice to raise standards by nudging patients towards better facilities”. Competition is the problem, and choice is the screen behind which it hides. We just want a decent local service. The comment before this shows the cynicism New Labour has created. Time to end the “project” for you careeerists and get back to Socialism.
If the country is so close to bankruptcy with a debt in the trillions etc, etc, making it necessary to plunge millions into hardship under the slogan “We are all in this together” (although some are more ‘in it’ than others) why oh why is the Coalition spending £2 to 3bn on reforming the NHS in England, only? The majority of the GPs don’t want it knowing that most of them couldn’t organise a vaccination programme in a flu epidemic. Before the Election it seemed to me that the PCTs would eventually come under the wing of Local Government which would have meant the replacement of all those centrally appointed boards of local (and not so local) businessmen and women with councillors and stakeholders.
The first change this new Tory-led government made to the NHS was to scrap waiting lists. Now, they’re already shooting up and I’m disappointed this hasn’t already hit the headlines. I dread to think how bad things are going to get. The NHS was on its knees in 1997; I fear we’re heading back there.