This week-end has seen numerous briefings against the Health Secretary. I have found him to be one of the best informed, and most accessible of Cabinet Ministers. He knows his brief well, is aware of the problems of piloting through change to the NHS, and has already secured the support of the overwhelming majority of GPs to his new proposals for commissioning.
The first criticism made of him is he has come up with radical reform proposals that were not explained to the public before the election. I have quoted liberally before on this site from the Conservative Manifesto to show this is wrong. The Manifesto on pages 44-49 went into considerable detail explaining the changes. It said administrative costs would be cut by a third by taking out layers of bureaucracy. It said GPs would be put in charge of local commissioning and would help patients by purchasing their care from a variety of providers. It said “We will give every patient the power to choose any health care provider that meets NHS standards, within NHS prices. This includes independent, voluntary and community sector providers”.
The second criticism is that these changes are somehow against the spirit of the NHS, and different from the kind of reforms Blair initiated. Again, this is wrong. All three main political parties and a large majority of the UK electorate strongly support the central idea of the NHS, that care should be made available free at the point of use on the basis of need. The care should be paid for by all taxpayers through their contributions to general tax revenues.
All three parties have long accepted the role of the private sector to help supply the free care for patients. The NHS presided over by Labour, Lib/Labour and Conservative governments have in the past relied heavily on for profit companies to supply all the drugs and other medical supplies used in the NHS. They have employed contract cleaners, caterers, management consultants, legal advisers, advertising agencies, recruitment consultants, property experts and the rest from the private sector to assist in managing the large service. The NHS has offered contracts to many doctors whom also run private clinics, or charge for additional services provided to NHS patients. The doctors were not nationalised when the NHS was set up. Much elderly care has long been provided in private sector nursing and care homes.
Labour also strengthened the idea that parts of the medical and clinical workload could be contracted out to private clinics and hospitals. They reasoned that if a private clinic could perform cataract removals or knee joint repairs to a high quality standard and the same or lower price than the NHS, they should increase NHS capacity by letting such contracts. Labour also used private finance extensively and often very expensively to build and rebuild hospitals and other facilities.
Like so many public services in the UK, the NHS is not entirely nationalised, though often misunderstood by its employees and some patients. It has never been the case that all the NHS assets are state owned, all the employees are on the state payroll, and all the supplies and services are provided by public sector suppliers. Some of Mr Lansley critics are trying to make out that there was some kind of golden age when the NHS worked well because everything was done in house by public sector staff. History tells us otherwise.
Some critics cry foul at the thought that the private sector might do what it can do best and at lower cost. Taken to extremes, that judgement would end all private contractors currently working within the NHS. Some argue that the Lansley reforms are back door privatisation, whereas the PFI/PPP/private sector contract regime of Labour was somehow not privatisation. These criticisms are not thought through. Healthcare in the UK is under the umbrella of free care at the point of use and will remain so. Beneath that umbrella there has always been a lot of mixed working between public and private sectors. Instead of being ideological about it, why not let patients decide where and how they want to be treated with the advice of their GPs. Haven’t we got beyond the yah boo of public/private, in a service which has many interactions and hybrids between the two?