Carry On Recruiting

Simon

Fraser There never would be another Conservative government if they went into an election promising job cuts in the NHS. I sometimes wonder what world you live in? Where have you been for the last ten years?

Guy Incognito

This question is academic: on their current dismal performance, the NHS is not going to be in Tory hands for a good while. But, since you asked, I'd improve things by putting Charles Moore in charge of the NHS. His contribution on *Any questions* in January was the most intelligent and coherent summary of the failings of the NHS that I've heard. It certainly beats anything I've heard from Mr Lansley. In fact, there's a good Boomer-friendly jingle: "Charles in charge..."

Trumpeter Lanfried

One is reminded of Attlee's advice to Professor Laski: a period of silence would now be welcome.

Dave B

"Can CoffeeHousers help me out here: how would the NHS (as opposed to the BMA) benefit from a Conservative Government?"

There wouldn't be any meaningful reform, which I suspect is what the NHS would like.

However, if the Direct Democracy faction within the parliamentary Conservative party is strengthened after the next general election, then health/NHS might possibly be devolved to local government, which would result in improvement.

http://conservativehome.blogs.com/platform/2006/10/tim_kevan_gordo.html

http://commentisfree.guardian.co.uk/james_graham/2008/03/im_all_right_darling.html

Mike

The conservatives have to promise to reform the NHS (however difficult), to localise it and make it locally accountable. As Simon says any hint of cuts will be electoral suicide - "Which hospital will you close Mr. Cameron" facile but effective negative politics. The truth is that NuLab has suffered provider capture and focuses on inputs (money, waiting times, the number of doctors and nurses) but the outputs are worse. Yesterday we learn (courtesy of Dr. Crippen) that after nearly 11 years of Labour infant mortality has increased! Our cancer recover statistics are appalling. There has to be another way. For than we need a new government.

Fraser Nelson

Come on Simon, do you really think it's a choice between "cut the NHS" or Lansley's stuff? This idea of a binary choice is the Modernisers' biggest error. There are a multitude of options on health, as Dave B indicated. Plenty coherent things Tories could and should be saying. Of course they should not campaign for staff cuts, but nor should they try to make a big deal about a tiny rationalisation. My question - a genuine one - was trying to establish if anyone even on this side of the political divide can think of a way the NHS would improve under Lansley's proposals of making the NHS a self-governing organisation, its elite independent from government.

Max Kaye

The truth is that the NHS is irreparable and unreformable. It may be politically incorrect (and possibly suicidal) to say so, but the NHS should not 'benefit' at all under a Conservative government.

Is there not any way of slaughtering this lumbering holy cow?

Verity

Max Kaye took the words right out of my mouth. They shouldn't announce it ahead of time, but once in, they should announce a new, reformed health service that will better serve those who pay into it. The new service would be what we call "private", but it would work thusly: There should be numerous healthcare providers - what the hell, they could even keep the ragbag remnants of the NHS if they wanted to. NI contributions would continue to be mandatory, and they would be for the same amounts. Except they would be credited to whichever healthcare provider the wage/salary earner nominated. If and when he gets sick, that is the private healthcare provider he goes to. So everything would remain the same, except the NHS be in fierce competition to be nominated for each individual's NI contributions. Or the NHS could be placed in the role of the county hospitals in the United States, where they provide medical care to the very poor, but those poor have to pay in installments, however tiny. Children and young people up to the age of 21 and OAPs would be exempt from paying. Everyone else pays, but he gets to choose the company he wants to take care of him. Anyone who hasn't made contributions for a set period of time - say three years, or five years - would have to pay for a proportion of their care out of their own pocket. Foreigners would be required to show they had sufficient funds for a medical emergency while in the country, or they would have to buy an insurance policy out of one of those machines, before he could get his passport stamped. Max Kaye, how did you manage to get spaces between your paragraphs?

TGF UKIP

"How would the NHS (as opposed to the the BMA) benefit from a Conservative Government?" Didn't you mean Tory Government, Fraser, 'cos there sure ain't any conservative government nor even a remotely recognisable Conservative Party government on any sort of horizon out there. I cannot offer any panacea for the NHS, I simply do not know enough about the organization but, I suspect, like many Coffee Housers, I have my suspicions as do many voters. And it is here that the first political task begins - to spell out how much the NHS in its current format costs each taxpayer and each household, followed up with the question "do you think you should expect better for that amount of money?" Like many, I also have my suspicions that within the 1.3 m employees, there is a comparatively large and expensive number engaged not on medical but on social engineering projects. The third item would be to put to voters the impact on NHS costs and therefore their taxbills in say just five years time if no reform to non medical costs and working practices is not undertaken. The whole issue begs the question of whether a state operated National Health System is appropriate, but I fully accept that pro tem nothing else is politically possible. In the meantime sensible, if brave, political thing to do (which guarantees no chance with Dave) is to open up the present and future costs of taxpayer funded healthcare for investigation by someone like David James. My preference would be to utilize the forensic and dialectical skills of John Redwood for this, but unfortunately there would be no possibility of this. The comparison would too quickly expose Dave's best mate, Boy George, for the powder puff politician he is.

HJ

Quite right, Fraser. Were the NHS a self-governing organisation, it would be controlled by the BMA (even more than at present). This would be even worse than top-down government management (hard though it is to believe).

The solution lies in localism, purchasing power residing with the patient and in tackling the power of producer organisations.

Verity

HJ - the answer lies in privatisation. How are other people managing to get spaces between their paragraphs?

Nicholas

TGF: "Like many, I also have my suspicions that within the 1.3 m employees, there is a comparatively large and expensive number engaged not on medical but on social engineering projects." Yes, and a very top heavy management structure too I should think.

When I was in hospital recently the nursing staff seemed to spend 50% of their time doing arcane things with paperwork, 40% of their time standing in little groups chatting about everything from internal hospital politics to what soaps they watched and 10% of their time administering medication, etc. I didn't see any real "nursing" or any real nurses, well not any of the sort I remember as a boy.

I'm afraid Florence Nightingale's nursing ideals - cleanliness and hygiene - are long forgotten. Modern nurses think cleaning is beneath them, hence the filthy hospitals.

Perry

It is not only HOW, but WHERE to make cuts. The NHS drags a huge and expensive baggage train of non-productive ‘workers’ (sic). Most are inordinately well paid (and pensioned) bureaucrats or hangers-on with little perceptible influence on patient care, - apart that is, to get in the way of real workers. The people in the baggage train are devoted to meetings. They generate or respond to ‘initiatives (sic), paper, unreadable reports of no consequence, and as such, epitomise NuLabore. Back in the real world, filthy NHS hospitals, - a national disgrace, - work on a struggling, defensive (‘in case we’re sued’), self-justifying and generally lop-sided basis. Real doctors and nurses (yes, some eccentrics committed to patient care remain), when they can be found, are ever burdened by nonsense preoccupations. The NHS should carry a government health warning itself, - it’s a dangerous place to be in, and for those that care, - to work in. Oh dear. It could and should all be so different. [Yes, - and how do some people manage to insert paragraphs in these comments?]

Simon

Fraser Of course there are options for reform. There just are not any that would be vote winners. I am sure Dave B knows a lot more about this subject than me but returning control of the NHS to local Government? No thanks. The best the Tories can do is appear committed to the NHS. Radical educational reform first. Then health reform in a second term. Follow your route and there just wont be a first term.

Perry

[My apologies for a second bite at this cherry.] The state of the NHS can best be glimpsed in the current preoccupation for teaching (!?) nurses to wash their hands. The significance of this – not lost on those who understand the deeper implications of what this means – is appalling. The culture of spin cannot negate or diminish that.

alex

In Singapore the government gives everyone a fixed amount of money for their healthcare (which is topped up if you get a chronic illness. So the patient decides how they spend their allocation and can add to it if they wish. I dont know hoe that would work in a bigger system, but it seems to me to have a lot of merit