Reviews, the future of the NHS, next year and a bit of a muddle
Filed Under (Health Policy, Reform of the NHS, White Paper) by Paul on 10-12-2010
Next week will be an important week for the NHS. Two very important papers will be produced by the Government. One of which will deal with the future of the NHS and one will deal with how the NHS will work in the next financial year.
The organisational approach to both these tasks will not just be different but will be at the opposite ends of any managerial spectrum.
On the one hand the Government will produce a response to the consultation that has been taking place consequent upon the July White Paper. This will demonstrate how they have been listening hard to what we have all been saying about their proposals but will, as a Government with a large majority has every political right to do, signal their intent to carry on with the reforms as they were outlined in that White Paper. These reforms contain many elements, but at their core is the notion that the NHS will be ‘liberated’ from central control and interference from the Department of Health and the Secretary of State. For the future of the NHS the old methods of central control will be abolished because the Government believes that they don’t work to the benefit of staff and patients.
On the other hand the Government will produce the NHS Operating Framework for 2011/12. This will recognise that the next year will see the smallest financial increase for the NHS for over a decade and that it will therefore be a difficult year. It will also recognise that during this really difficult year many of the organisations that will be managing that difficulty will begin to be abolished and many of the staff who are responsible for seeing the NHS through those difficulties will be made redundant. The Operating Framework will respond to this by demonstrating much tighter central control, especially over money. For 2011/12 rather than liberation we will see much much tighter control from the DH and the Government. For 2011/12 staff and patients will have a much better deal because of tighter central control.
You may well notice that these two approaches are not the same.
The Government, when dealing with the hypothesis of how the NHS might operate in the future, argue for liberation and the removal of their interventions from the NHS.
However the Government, when dealing with a real live NHS issue – next year’s budget, believe strongly in central control and intervention.
To me this demonstrates that they don’t really believe in the practical application of their own reforms.
If they feel that liberation works, now is the time to prove it.
If they feel that central control will work in 2011/12 why isn’t that the answer in 2013/14?
This would lead us to believe that they are ideologically in favour of liberation but practically in favour of intervention.
Next week will see the Government in power for about 7 months. My next post will try and explain how in that short period of time they have got into such a ridiculous position.
Dear Paul,
You illustrate a classic problem with markets in healthcare, here – the need for central control and a massive associated bureaucracy.
The White Paper is a proposing an even more “liberating” market based healthcare system than New Labour’s previous system. Therefore, we are seeing the need for central control and oversight to limit/modify the effects of its potentailly destructive effects (i.e Schumpeter’s “creative destruction”). The market simply cannot be left alone. It also needs a massive information system to work, as well as highly complex contracting due to the PP split and the plurality of “any willing providers”. This is a very expensive bureaucratic system that requires “double accounting” and needs Treasury oversight (i.e more central control).
It is no co-incidence that Thatcher’s reign as PM was characterised by free markets and a strong state. Market failure (especially in public services. like health) requires strong central control. Otherwise MPs lose their seats in constituencies whose hospitals suffer from the market phenonomen of “exit” (and Governments often “exit” soon after).
It is time that the policy wonks started to understand that markets do not work well in the delivery/provision of healthcare. For example, the idea that patients want choice rather using their local hospitals is based on Julian Le Grand’s analysis of the British Social Attitides Survey (quoted in DH literature). This was a questionnaire of the public, NOT patients. Translating results from public opinion to patient opinion is a basic schoolboy error. I am a cancer specialist and my patients want a service closer to home because they fell too unwell to travel and want to have close family support, which is a key part of their overall care. This is true for any serious illness. This is why GPs want to refer to patients to their local hospitals (which patients want too).
This is therefore a fundamental problem for market advocates. That is why they will need EU competition law and the msucle of Monitor and the NCB to force the market on the NHS.
Professor David Marquand was correct when he said that public service professionals are “in a profound sense, not just non-market, but anti-market”. This is not suprising considering one of the key underlying theories to promote markets in public services (Public Choice Theory) is based on distrust of the professionals/public servants delivering the service! This is the “Knights and Knaves” stuff that Le Grand has written about.
Policy makers need to understand that if they start out with a policy based on distrust of the people they want to deliver the service, is it any wonder that they encounter resistance to change?
[...] that the centre will tighten control over the budget for 2011/12. A very interesting dichotomy that Paul Corrigan has already emphasized and reiterated at the Intellect Healthcare Christmas Lunch yesterday: [...]