Ok, so after the two month consultation into Andrew Lansley's 'controversial' NHS reforms, the bill now looks visibly different if taken at cosmetic face value. The 2013 deadline by which GP's were to take control of funding has been removed, with that management of budgets now set to also include doctors and nurses. Any switch will now take place "when GP's are good and ready" in Mr Cameron's own words, which of course offers the prospect of many being at that "almost there" stage on an ad infinitum basis in the coming years. Other changes include the creation of clinical senates to oversee patient care, confirmation that the 18 week waiting time guarantee would stay in place and a rather vague pledge only to allow wider competition for services "when it improves patient care and choice". I was under the impression that more competition increased choice by sheer definition, weren't you?
Unsurprisingly, the anything but Liberal Democrats are delighted with what one of their MPs, Andrew George, referred to triumphantly as "an effective U-Turn", while many backbench Tories are said to be spitting blood. From the outside looking in, I can't help but think that in practical terms they were fighting over what was a very small plot of land in the first place. "Privatisation by the back door" rolls off the tongue quite neatly as a line of attack, and is a convenient stick with which to hit Lansley, a distinctly mediocre political operator who should probably be locked in a cupboard for a while. However, the NHS would still have remained a taxpayer-funded organisation whose funding was protected from the fiscal realities that apply to most of us. The day's other promise from Number Ten, namely that of committing us taxpayers to further increases in NHS spending, was merely a regurgitation of a pledge from last year's highly depressing election campaign.
Apparently David Cameron 'loves the NHS' as much as anyone. I can't help but think that his need to state such open emotion towards a legal entity is a substantial part of the problem. While I support in principle any move such as that of the original proposal, which shifts decision-making power, funding and accountability to the most local possible level, surely in the grand scheme of things these are not the sort of earth-shattering questions that the Westminster Village would have you believe? In reality, this has been an argument over whether to apply one form of statism or another to the NHS, with fag paper differences wildly exaggerated for the benefit of tribal theatre. I have no idea whether or not Dave's affection for a state institution is kosher, but he either feels compelled to profess a false state of undying love for political means or he genuinely does love the National Health Service – either way we are in a sorry state of affairs..
Whenever politicians talk about the NHS, they first queue up like Goneril and Regan, King Lear's treacherous daughters, to indulgently espouse the warmth they feel from the bottom of their hearts for 'what we all regard as a national treasure'. It has gone way past nauseating and stopped turning my stomach a long time ago. Now the natural response is to either switch the channel over or at least cover my ears until the picture changes. Perhaps I'm committing an act of treason by saying this, but I genuinely do not 'care' one iota about the NHS. What matters to this bunny more than anything is the availability of quality healthcare to the general population at an affordable price - and if you subscribe to the view that people invariably get better value for their own money than the government ever could, it is virtually impossible to see where a taxpayer-funded monopoly with guaranteed funding becomes part of the solution.
For example, take the notion that competition will only be introduced "when it improves patient care and choice". As always, the critical question begs to be asked:- who exactly gets to make that judgement call as to whether or not it represents an upgrade or a more cost-effective solution? The best person to make that judgement is not a GP, or a nurse or god forbid, a politician but the patient himself. We now have the strange paradox in the public sector of a state which on the one hand promotes 'choice' for its customers but then reserves the right to dictate exactly what that 'choice' entails. Regardless of whichever wooly slogans the LibLabCon will drag out to worship at the altar of 'universal' healthcare, the true ethos of the NHS remains that of the state being in the driving seat, with the paying passenger having to settle for what he or she is given.
Real choice of course involves having the right to take your business elsewhere, as you would in almost any other walk of life. Were some of Britain's failing, MRSA-ridden hospitals private enterprises, not only would there be a national outcry about the cancerous effect of 'the profit motive' but the hospitals themselves would be closed, if not by the inspectorate then certainly as a result of a mass exodus of customers. The truth is that in terms of performance and outcomes, many NHS hospitals would have gone to the wall as standalone entities some time ago, and have only been kept alive by the insulation of their funding and the institution's undeserved status as one of Britain's 'sacred cows'.
Were they competing with private providers in a voucher system (my preferred solution as opposed to compulsory private care, as some may have presumed), then it would indeed be interesting to see what sort of choices the paying public would begin to make. The local NHS hospital would be competing for the value of your voucher while a private one may seek a small additional amount as a top-up. Many of the 'squeezed middle' who have found themselves penalised and inhibited for the best part of two decades would suddenly be presented with the opportunity to escape the state monopoly and spend their money where they saw fit. The good NHS hospitals would no doubt thrive while what passes for others would soon be driven out of business – surely this is a fair and meritocratic end result?. There is no point lying - state healthcare may well end up in this scenario as the second tier preserve of the unemployed and least well off, but only if it deserved to be.
Had the government returned from their two months out to 'pause and reflect' to put the proposal of a voucher system on the table, then despite the concept itself not being all that radical in reality (Malpoet will soon be on to confirm this), it would still have represented a shift in ethos and a significant talking point. As it is Nick Clegg and his friends have screamed their marginal differences with the original proposal to the rooftops and appear to have won a moral victory in the form of one or two aestethic 'concessions'. What we have ended up with is yet another restructuring, more edicts, targets and initiatives, with further tinkering around the margins, not that the bill put forward in the first instance was significantly better, it should be added. New Labour may have left office a year ago, but their modus operandi remains right at the heart of government.
Until we can shift the terms of the conversation to the point where it is about healthcare in general terms and not the 'sacred cow' of the NHS, then the real measures required to drive up standards and penalise failure will not be allowed to take place. Successive governments have constantly adjusted the shape, scope and structure of the health service while throwing unprecedented sums of taxpayers' money into the bottomless pit that it has become. All have failed to oversee a rapid climb up the European league table in terms of outcomes, which was of course the original stated aim. When we are able to engage in an adult conversation about healthcare, we might get the notion of a shift in culture (ie - the way we do health as a country) off the ground. Like comprehensive education, the NHS in its current form has long outlived its usefulness, and I make no apologies for failing to 'care' about it sufficiently.