David Cameron claims to be the friend of the NHS. But the Conservative leader revealed his hand in last week’s health speech. His policy is naive and sinister.
Leaving the buying of all NHS services to GPs is a potential a recipe for chaos. As the small business people of the NHS, GPs do not feel obliged to take on tough decisions on where to deploy resources. GP commissioning is counter-cultural, not ideological.
Scrapping all targets is a throwback to the NHS of 1997, when a postcode lottery came as standard with GP fundholding. In those days there were no national standards for key diseases and waiting times were an embarassment. Targets underpinned Blair’s “funding for reform” deal for public services, and few NHS staff wish to return to older people spending 12 hours on A&E trolleys, a routine story in the 1990s. Other targets, for example for heart attacks, heart failure, cancer and stroke, though challenging have transformed patients’ lives through better outcomes.
Pay based on outcomes has already begun – NHS-wide hospitals’ incentive payments start in April for common conditions including cataracts and hip fractures. Improving outcomes is Labour’s unsung triumph, from the first NHS national standards across a range of diseases, to creating a clinical regulator and independent judge of new treatments in NICE.
More private providers of NHS services is the sinister bit. David Cameron said, “With a Conservative government any service provider from the private or voluntary sectors will be able to compete on equal terms for a NHS contract.” This is a throwback to Michael Howard’s “Patient Passport”, where patients choosing private sector treatment got 60 per cent of NHS costs towards their private bill. (In reality, Labour has only dabbled with private provision at the margins – a short-term capacity boost to reduce waiting lists).
So with commissioning given to GPs and “bureaucracy” decimated, who will hold them to account to create a seamless service for patients?
Cameron’s speech had minimal media scrutiny. As policy was it really naive, or a deliberate recipe combining small government and a large dash of market forces?
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