Wednesday, April 07, 2010

Conservative health policy - can you spot the contradictions?

The recent announcement by the Conservatives that they will provide cutting edge cancer drugs to those that need them is, as usual, pretty good politics. Yet it is another spending commitment which indicates that, whilst flashy rhetoric is a strong point, financial management and an understanding of basic bureaucracy is still sadly lacking. I was, however, moved to see what else the Conservatives have to say on health...

Featured on Liberal Democrat VoiceThere are some apparent contradictions between their stance on devolved decision making and their stance on access, for example;
  • they will 'devolve decision-making closer to patients'
  • they will 'create an independent NHS Board to allocate resources to different parts of the country and make access to the NHS more equal'
I think that most liberals would support the former, but if you're devolving power at one end, why give power over resource allocation to an independent body? Who sits on such a body? How is it accountable and to whom? Or is this just another quango, of the type the Conservatives have sworn to abolish?

Indeed, by allocating resources from the centre, and standardising access - because that's what 'making access more equal' means - how does that reflect devolution of decision-making? Surely, if your patients decide to allocate resources in a particular manner, unless they all make the same decision, access will not be equal.

Moving on though;
  • they will 'scrap all of the politically-motivated process targets'
  • they will 'measure their success against those countries with the most effective systems of healthcare'
Not all of the politically-motivated targets then, or at least, the introduction of a different set of politically-motivated targets. And, in any case, what does 'most effective' mean? Is that in terms of survival rates, is it in terms of cost? And that is an important question. If you're a cancer patient, the most effective treatment is the one that cures you. If you're controlling the budget, it's the one that saves most lives at the lowest cost. Both are the correct answer, and each is irresponsible when looked at through the eyes of the other.

The implications of a market in healthcare appear not to be understood either. The Conservatives will give everyone the power to choose any healthcare provider that meets NHS standards. Whilst that, once again, looks very attractive, it assumes the existence of spare capacity in the health system. That spare capacity costs, as spare beds need to be kept in good condition even if they're not being used. Also, if customers gravitate towards the best, you will need to find additional resources to allow those providers to extend their level of provision. That means additional expenditure, and with inflation in the health market consistently running above that in the economy as a whole, and the burden of geriatric care moving in one direction only, it is hard to see where the funds will come from.

Yes, the Conservatives offer to cut one-third off of the cost of NHS administration. Yet they promise an 'information revolution', making detailed date about the performance of trusts, hospitals, GPs, doctors and other staff available online. In principle, that's a great idea. However, you need an army of staff to gather that data, the very staff who are to be culled in vast numbers. Add the commitment to compare a performance with our neighbours, and you build into the system great swathes of bureaucracy, causing people to count things, and not actually delivering any healthcare. They will also link GP pay to the quality of the results they deliver. Again, more number crunching, more staff needed to do the monitoring.

There is a lack of consistency here that may well be exposed, and if the Conservatives don't show some fiscal discipline soon, the currency markets may well take the decision out of their hands.

1 comment:

Fred Harrison said...

Excellent analysis. And it goes straight to the heart of Cameron's strategic dilemma. His "big society" theme sounds marvellous, with its local solutions and its reliance on citizen action. Lovely. But wait -- what about all those postcode lottery situations his MPs (and the Daily Mail) love to harangue the government over, in health care and education especially? So national standards no longer matter?