Left a bit, right a bit...29th April 2006
In a world where both Labour and Tory health policy seems to be similar - and equally ineffective - is there a safe ground for the NHS? asks Steve Iliffe. Both parties are seeking the holy grail of lower taxes and better services, both are promoting a recipe of more choice, greater competition and local autonomy, backed up by strong leadership to raise higher standards. So is there a credible alternative model?
Under New Labour, investment in the NHS has been unprecedented and is set to reach 9% of GDP by 2008, in line with the European average. While this is seen as a positive step, there are concerns about the accompanying productivity - or lack of it - and whether the NHS is delivering value for money. Half of the investment has gone in highr salaries. Of equal concern is the NHS' ability to deliver the welter of targets and standards issued by the government. Not only are there so many reckless plans across so many healthcare activities that hospitals and PCTs struggle to match spending to commitments but the problems will worsen in those organisations already in deficit and could bring the NHS to the point of bankruptcy by 2010, according to Reform, a heavyweight think-tank.
The answer, according to Reform, is to devolve management to a local level and introduce more private sector participation. PCTs should ruthlessly set about commissioning services - and stop providing them - with the aim of increasing productivity and value for money. Investment should be in the form of more flexible local schemes, replacing the centrally planned private finance initiative programme, which has no far only produced impressive buildings but at huge cost and with fewer beds.
The proposals in Our Health, Our Care, Our Say allow the government to play the consumer card but effectively begin another tranche of service reforms in the community which must all be financed from the same budgets that are already under pressure. The result is that consumer demand, encouraged by state policy, will drive services in one direction while budget pressures pull in the opposite direction.
Inevitably, this must result in frustration and dissatisfaction with NHS services and will play into the hands of those in favour of an insurance funded healthcare system. If the strategic direction of the NHS is unclear, the battleground on which it will be determined is taking shape. And it is a battle between creeping privatisation and the sacred cow of a publicly funded and owned NHS.
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