Wednesday, January 23, 2008

The left knee doesn’t know where the right knee is jerking

The Lib Dems are trying to have it both ways.

I know, I know: it’s almost impossible to believe such a thing of the party that has made its name driving opportunism and inconsistency out of politics. I was every bit as shocked as you.

Shiny new definitely-not-David-Cameron leader Nick Clegg has been writing about the NHS: “We are entering a new era for public sector reform. Labour's approach – more money and more central control – has reached its limits.”

He pours particular scorn on “gross inequalities” in health between rich and poor areas – although his implication that these are due to the NHS seems to ignore the many income-related lifestyle factors that affect health. His diagnosis (as we are legally obliged to call any political assessment of the NHS): “The centralised system has failed for the people who need it most.”

He wants to see a more bottom-up approach (I’ll forgo the colonoscopy joke); indeed, he wants “a People's Health Service”.

(As well as definitely not being David Cameron, he’s definitely not Tony Blair either.)

I wonder. Clearly there’s a case often made that more ‘localism’ and patient input into the NHS could generally improve standards. But there’s no reason to think that such a move would promote equality. The more variation you have within a service, the more – how to put this? – variation you have.

To compound this, Clegg proposes: “Communities should have the right to raise, or lower, a local income tax to suit the needs of their health service.”

Perhaps they should. But making health spending more dependent on the amount of tax that can be raised locally means that richer areas will have better-funded services and poorer areas worse-funded services.

These ideas may have some merits, but reducing health inequalities isn’t one of them.

So much for the money. How will his plan work?

A People's NHS would replace top-down targets with personal entitlements to high-quality care. To drive the NHS to deliver, everyone should have the right to private treatment, paid for by the NHS, if the waiting time is not met.

Target-bashing is a great sport these days, and Clegg’s keen to join the game. I’m not completely sure, though, how we’ll tell whether “the waiting time” is “met” without some sort of target.

And what’s this in the very next paragraph? He says that the treatment of mental health patients “is a national disgrace: there aren't even targets for mental health treatment, let alone entitlements”.

Too right. If there aren’t targets, things must be bad.

1 comment:

Miller 2.0 said...

I think this is quite interesting; 'choice' is also about variation, so it would seem that all the major parties are in agreement about what they would like to see come out of the process of NHS reform in terms of delivery.

For me the problem is that we try to 'deliver' at all; it's a rather outdated bit of old-labour NHS thinking that all parties, even those advocating choice or variation, still fall for.

They see the NHS as being like a machine with levers to be pulled, either by the government, or the private sector. This attempts to deliver for patients and can be very efficient at doing so; but none of the approaches of any of the main parties attempts to better gauge what patients actually want.

I would argue for a co-productive approach, using citizens juries, local health co-operatives and a politically independent NHS. I would also remove market driven competition, because although it measures market forces in terms of what patients want, it also limits them by not letting patients take part in the process of deciding how care is to be delivered themselves.

It also distances front-line staff from patient needs.

The NHS must become less mechanically driven and more 'systems' driven; the targets we want to achieve aren't always the targets patients prioritise, and sometimes, like 48 hour surgery waits, they are plainly absurd.

They may be a political convenience (you can drop emphasis if you fail one, blame reshuffles for poor performance etc.), but that is no ambition.

On co-production and democratic patient input, only Labour can have the answers.