There are a lot of people who’re more in touch with the detail than myself. But as this blog represents a record of what one person living in Britain thinks, then it’s something I ought to write about.
But I’d just like to add my inconsiderable (sic) voice to those who think that this has been a shambles. (My apologies, btw, if this item lacks any apparent structure – although actually, that reflects my gut feeling that something baaaaaad is going to happen here)
It’s not a promising start …
In common with other Conservative ministers, it looks like Andrew Lansley has had years in opposition to understand the health service, to identify where it’s not really working and … well … come up with some ideas.
Now, Mr. Lansley seems like a relatively honest politician. Everyone seems to say that he’s put a lot of effort in (while in opposition) to really understand the health service and how it works.
So it’s a real shame that he didn’t actually talk through these proposals with those involved providing healthcare – often at minimum wage, and historically motivated by a vocation. This from a government who regularly accused its predecessor of arrogance and bullying. Being liked and respected doesn’t always mean you’re right.
So now the Nurses have come out with a overwhelming vote of no confidence in him.
And the BMA doesn’t support his plans. When questioned, Mr. Lansley trots out the line that “80% of GPs have volunteered to sign-up as pathfinders” – but as Left Foot Forward quotes one GP,
“Just because passengers got in lifeboats on the Titanic did not mean that they supported the ship sinking.”
So now we’ve a “pause” for “listening” and “reflection”. But not actually an acceptance that you may just have come up with a really bad idea.
So What could Possibly Go Wrong ?
The plan is to move a massive chunk of the NHS budgets to GPs, to reduce two levels of bureaucracy.
This is where things get messy, and factors come into play that politicians and bureaucrats always fail to consider – the impact of individual motivations and behaviours of people on the dynamics of organisations.
Most GPs are very smart people (most of the ones I’ve met are much brighter than me), but they aren’t trained in optimising procurement processes. So the GP consortia will probably employ administrators to do the work for them … or, of course, they won’t have time to actually see their patients. Many already have practice managers to make sure they’re hitting performance targets and tell them when they can book holidays.
So we’ll be replacing a specialised – albeit centralised – group of administrators with a far more diverse group, whose relative performance will be much more difficult to benchmark.
Now, I’m not a Stalinist. I’m generally in favour of delegation and decentralisation. Unfortunately, the reality is that government functions probably work more effectively when there’s little scope for initiative – as we can see at the moment, anything “optional” is the first to go under “cost saving” initiatives, and performance is driven down to the lowest acceptable level.
Where’s it all going ?
Many people think that the net effect will almost certainly be that commercial providers enter the market. They’ll dominate potentially profitable areas by offering “loss-leaders”. Then when the NHS has no public capacity, the price – and that includes the price to taxpayers – will increase.
Despite government assurances that commercial providers won’t be able to “cherry-pick” the profitable bits, that’s what is already happening with the private sector (which – anecdotally – won’t touch the difficult cases). The provision of healthcare in the USA isn’t a model most Britons would find acceptable.
(One additional factor appears to be that European Competition Law may come into effect. The attitude of the government seems to be that this is a detail that can be sorted out later… although it’s likely to be absolutely fundamental to the operating model.)
Personally, I fear that the commercial providers will strip these budgets. Any consortium who doesn’t select them will face being bogged down in competition law and other litigation – in the same way that supermarkets seem to get built whether or not residents want them.
I’m concerned that our taxes will end up going to prop up some corporate balance sheet in the USA. And I’m concerned that after our national assets have been pillaged and our national resources stripped, that I’ll wake up one morning and wonder where our healthcare system has gone.
[Edit 19/4/2011]
On further consideration, I can see the following roadmap:
1) GPs get bored of this stuff an appoint “procurement managers” (as above)
2) After 3 years, corporates (such as Capita) start headhunting the competent procurement managers and offering a procurement service.
3) After about 6 years, your 78 year-old mother will get a phone call from a call centre in Mumbai to tell her that her hip replacement is scheduled for the new Capita Centre of Excellence “quite near” Bucharest.
To sum up …
We’re now being promised “substantive change” to the proposals, but most people think that this will just involve tinkering with the implementation.
At the heart of it, there’s no mandate for such a massive change to the NHS. If the Conservatives felt these changes to be so necessary and desirable, then they should have included them in the manifesto and campaigned on them last year. But that might have lost them votes.
I’ve tagged this under “dysfunctional government” because I can see this going horribly, horribly wrong. And – once it does – I fear it will be almost impossible to unwind.
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