This week the changes to the NHS have at last come centre stage in the UK political debate. I am starting to receive emails disagreeing with the government’s plans.
There are two common criticisms of the Lansley proposals which I need to dismiss before we can begin intelligent discussion of them. The first is that a very radical reform of the NHS was not mentioned in the Manifesto or before the election, and has suddenly been sprung on the country. The second is that the government’s plan is a way of privatising the NHS.
The NHS was treated differently to other areas by David Cameron between 2005 and 2010, because he personally relied on it for his disabled child, and wanted to reassure people that he believes in it. He made Andrew Lansley Shadow Health Secretary and guaranteed his job for the whole of the last Parliament, unlike all other Shadow Cabinet members. He instructed Mr Lansley to immerse himself in the culture and problems of the NHS, and to come up with a way of improving it. He protected the NHS from any future cash cuts by offering to increase spending on the NHS by a little more than prices each year of this Parliament.
Mr Lansley energetically got around the NHS over the last five years, and produced detailed policy papers in opposition, setting out the direction of reform he wished to undertake should he become Health Secretary. These papers received very little publicity. The Manifesto itself confirmed a radical plan for changing the NHS. It said:
“We have a reform plan to make the changes that the NHS needs. We will decentralise power, so that patients have a real choice. We will make doctors and nurses accountable to patients, not to endless layers of bureaucracy and management”.
The plan always included the central proposition that GPs should buy in the hospital care and other services their patients needed, removing commissioning from PCTs and phasing them out. Some of us spent time in the election explaining to the few people interested how these radical plans might work.
I also wrote a website piece explaining that the media were wrong to think the education plans were radical and the health plans were not. I suggested that the NHS reforms would prove to be bigger and more important than the schools plans. It is quite untrue to say there was no warning that change was afoot, and untrue to think the main outlines of the reforms were not explained before the election.
Nor is it true to say the aim is privatisation of the NHS. The crucial promise of the NHS that is very popular in our country is the promise that everyone has access to care, free at the point of use, based on medical need. The Manifesto made clear that that was fundamental to the Conservative party approach:
“As the party of the NHS, we will never change the idea at its heart – that healthcare in this country is free at the point of use and available to everyone based on need, not ability to pay”
The NHS has never been a fully public sector owned and run service. From its foundation, GP practices have remained as private businesses, contracting with the NHS to provide NHS services. They often provide private services as well, from innoculations and other paid for items of service through to dispensing and charging for presecriptions. From its opening it has bought in large quantities of drugs from private sector for profit companies. It has put work out under contract to private sector companies of all kinds, from catering and cleaning through to specialist nursing and clinical services. Labour expanded the private sector role, finding some private sector businesses could offer higher quality medical,nursing and clinical service for lower cost.
The Lansley reforms build on this mixed base of provision. Again, the Manifesto was very clear. It said:
“So we will give every patient the power to choose any healthcare provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers.”
It went on to explain
“We will strengthen the power of GPs as patients’ expert guides through the health system by
giving them the power to hold patients’ budgets and commission care on their behalf
linking their pay to the quality of their results
putting them in charge of commissioning local health services”
I hope following this I will not receive more emails and letters suggesting the Conservatives failed to explain their plans before May 2010, and no more suggesting the aim is to undermine free at the point of use. It is important to grasp that the NHS has never been an entirely state run operation. Tomorrow I will look at the challenges faced by Mr Lansley in implementing all this.
The UK debate as always remains distorted by people who do not understand the numerous hybrids we have between full private sector for profit competitive provison on the one hand, and full scale free at the point of use with all assets owned by the state and all employees employed by the state at the other.