The Coalition’s NHS Bill has undergone just over a thousand amendments since it first began to germinate in that small space occasionally referred to as Andrew Lansley’s brain. The majority of them, it seems, have been pasted in and patched not by the Opposition (which has little constructive to offer on the issue) but by Liberal Democrats who don’t know what they’re talking about, yet do realise that they must have some effect on something pretty soon, or they’ll be wiped from the map of UK national politics in 2015.
Now, a group of 240 doctors (see today’s IoS) have grouped together and are vowing to stand against MPs who vote for the bill. Single-issue candidates rarely win at General elections, so it feels like all they’ll get for their trouble is a lost deposits bill for £120,000. My own view is that the money would be better spent trying to get some media quid pro quos and sympathisers to turn the sum into some full page ads (or free website editorial) in the press and online, on a trailed day just before the election. These would do two vital things: first, name the guilty lobby-fodder who voted for it; and second, explain to the confused of Britain WTF they’re on about.
Apart from saddos like me (I’ve been on Lansley’s case since mid 2010) I don’t know a single person outside the NHS who has even the remotest idea what the argument is about, or where the real truth of the debate lies. It is a tribute to David Cameron’s ‘style’ of government – and Andrew Lansley’s capacity for tramline political theology – that between them they have made the public health debate even more dense and opaque, in fifteen months flat, than the ongoing pie-throwing contest between climate warmists and deniers. But to be a little more fair, the failure here is also one of a media set driven almost entirely by a fierce readership/hits battle, and other commercial concerns such as bankruptcy, as a result of its own technological and policy myopia. As well as a bit of criminality here and there.
Not since June 2011 has any major national press title given us an idiot’s guide to the Lansley Bill. Since then, the amendments have changed it into something for which we would need a Galactic Hitchhiker’s guide. But the fundamentals remain the same, so if I may I will point them out again, and my objections to them in red italics.
1. Lansley’s basic idea is to give 80% of the health budget to the primary care sector (GPs) and ‘give hospitals more control over their destiny by reducing Government control’. The Bill’s starting point is wrong, full stop. To give GPs even more money is patently daft, when the real need for infrastructural and techno-investment is at the hospital level. You don’t give hospitals more control over their destiny by starving them of funds. You do that because you want private health companies to buy them all at a knock-down price, and thus remove a persistent headache Whitehall has in terms of how to fund them.
2. These lucky GPs will then form themselves into buying and commissioning groups. To further confuse what the point of these might be, Lansley proposes an NHS commissioning board to ‘oversee’ their activities (oh dear) and an organisation – working title HealthWatch – which will give nosey and ignorant patients a say in what’s happening. This is such an obvious, tangled mess waiting to happen, it is not even worth deconstructing.
3. The admin of the groups will be handled by ‘people currently working at primary care trusts (PCTs) and strategic health authorities (SHAs), which will be scrapped under the plans’. This part is Whitehall’s ‘contribution’ to the ‘reforms’, and consists of a naked attempt to ensure that all the pen-pushers retain their jobs in one way or another. Thus the NHS’s second biggest problem – far too many admin folks – has been fudged completely, and little or no money will be saved.
That’s it, actually. That’s all there is to the Bill. Read the amendments, and you will quickly grasp that the LibDems have basically turned a schizoid Bill into an obsessive compulsive disorder. But the basic and core daftness of it remains exactly the same.
The point 1 above is for the greedy GPs who don’t do weekends or visits any more, the Tory Right who are having privatisation withdrawal symptoms, and the private health combines just gagging to get their hands on those hospitals. So for once, when the Left calls it creeping privatisation, they are right. It is a symptom of the sterility of our politics, however, that 67 years after the end of the Second World War, we have not progressed beyond nationalisation and privatisation. That is especially astonishing given that neither solution would be to the long-term benefit of patients in particular or Great Britain’s finances in total.
The fundamental problem that we as citizen voters face is that both the major Parties are working to a busted agenda rather than real needs. The Labour Party has never, and will never, learn that nationalised industries are wasteful and a drain on resources; while the Conservative Party – despite myriad examples since 1979 – will never learn that you simply cannot hand over vital services to a commercial culture that mislaid its moral compass some time around 1982.
My plan for the NHS is extremely simple and would, I venture, get the support of most electors if put forward. I’m calling it Slogplan A.
That is, to fire every civil servant from the health service by simply removing it from any relationship to government: but giving the entire thing mutual trust status so that it can never be taken over by profit-motivated business…and ensuring that every patient has a stake in the enterprise. And finally – there is more to this than brand-wank – dropping the ‘National’ part from the name. It should be called the Community Health Service. I mentioned earlier the NHS’s second biggest problem. Its first one by miles is the sheer size and complexity of the thing: responsibility must be devolved to community level. Then, in the end, communities will get the public health services they deserve….not a costly privilege they take for granted as one of their many assumed ‘human rights’.
All non-plc building societies, Waitrose, John Lewis and the Coop work on this basis, and work perfectly well. They also, on the whole, produce organisations with higher ethical standards and more honesty in their dealings with the public…and generate lots of profit for investment in the business.
Although the mutual commercial solution has made some ground in the years I’ve been banging on about it (and has a growing number of enthusiastic supporters in the media) it won’t be enacted by any of the Establishment Parties: because one or another of their grubby, tattered wings wouldn’t approve – and any attempt to would anyway be sabotaged by the Mandarins, who will never allow Whitehall to shrink. Not even the Mad Handbag managed to achieve that, and she was as determined as we’re ever likely to get.
Far more likely is that this Bill will pass, and within ten years a large proportion of the population will not be able to afford hospitalised health care. The market will be handed to US companies and general insurers, all of whom will under-cover and over-charge. Labour and the Unions will demonstrate, but get nowhere, because their idea of a solution is simply more jobs for the boys: and that one got found out years ago.
So my final plea would be this: Slogplan B. Drop all the LibDem amenditure bollocks, and add one big one: there will be an open auction of certain hospitals and their Trusts to the highest private-sector bidder, but the downside is that a mutual company rakes off 6% of all pretax GP and Hospital profits every year. (It has to be pretax, otherwise most of the money will go straight to the tax accountants and offshore banks).
That company – again, with no connection whatsoever to Westminster or Whitehall – will then sell low-cost, fully comprehensive health insurance to the less well off, and other people with more sense than money. With a bit of luck, within a generation the open market insurers will go bankrupt, following which we can revert to the Slogplan A we should’ve had in the first place.
You see, if you don’t have lobbyists, extremists, dinosaurs, Party contributions and trade unions to worry about, there is a relatively simple, realistic and radical solution to most of the UK’s festering problems. Just don’t hold your breath waiting for that long-hoped-for New Dawn.