A very interesting analysis of the election campaign and the politics of the NHS in today’s Guardian:
The weekend polls pointed to a sudden shift in the political weather, but the vicissitudes of party conflict are underlain by the everyday concerns of the voters, which move at glacial rather than cloud-like speeds. Foremost among them is the NHS, recently ranked by Ipsos Mori as being second only to the economy in determining how the nation will vote. You would hardly know that from the coverage of the campaign so far. Still less would you guess that the Conservative party is planning to entrench a regime of competition which could shake up British healthcare just as dramatically as the leaders’ debate has shaken up the election.
The relative quiet over the NHS is in part a tribute to Labour’s record. Thirteen years ago winter crises arrived with Christmas, and many people died while waiting for surgery. The survival of the service itself was not guaranteed, and right through the last two elections the Conservatives proposed diverting funds into subsidising private medical insurance. Labour won that argument and nudged the whole debate to the left. The Tories have not only ditched their old policy but are now committed to spending (slightly) more on health than either other party. To acknowledge all this is not to deny some serious stains on the government’s record. Foremost among them has been an obsession with shiny new hospitals of the sort in which Labour launched its manifesto last week. As the money dries up – and make no mistake, it soon will – the damage done by this preoccupation will show. Investment in community healthcare that can keep patients in their homes is urgently needed to make the NHS sustainable through the ageing years ahead. Fewer such investments will be made due to the resources committed to paying off all those costly PFI deals on new infirmaries.
The Conservatives’ big idea for making scarce resources go further is their trusted formula of market forces. The party’s tactic of hugging the doctors close obscures this, as does its energetic campaigning against every hospital merger. Indeed, the real strategy is only half-evident in their manifesto, which bemoans targetry and proposes a new board to divvy out funds. One detail that does not make it into the little blue book, but which is plainly set out on the Conservative website, is a new economic regulator, with a remit to “promote competition”.
With the Conservatives now committed to paying for the NHS through taxes, and with Labour accepting a role for private providers, it can seem like there is little to choose between them. But, as the postal sector demonstrates all too clearly, an economic regulator can unleash a whirlwind. After ministers handed Postcomm supervisory power over Royal Mail, it interpreted its pro-competition remit so zealously that it forced the operator to maintain relatively high prices on bulk deliveries, to ensure that private rivals had the chance to undercut. While big businesses have enjoyed access to new couriers, Royal Mail itself eventually reached such a dire state that the Hooper report urged the government to rewrite the law to clarify that competition was a mixed blessing. And in healthcare, the final legislative recourse against independent regulation might not be available, thanks to the pro-market drift of European competition law.
Independent health regulation might prove irreversible. It would without question drive those hospitals and surgeries deemed less efficient to the wall, and it would also attract new business players into the market. Good thing too, say its advocates, who believe that it is only through such means that productivity will be forced up. Others, including the Liberal Democrats, who caution that marketisation must not overpower democratisation, might worry about hospitals being taken out of elected hands. But whatever its merits, an economic regulator is surely one idea whose health deserves careful scrutiny before polling day.