The Tory health policy, as it stands, defies understanding. There are various, welcome plans to broaden the supply of providers – but they start with a proposal to grant operational independence to the NHS bureaucracy. Cameron calls this the “NHS Independence Bill”; its intention is to assure the poor NHS staff that government will not be reorganizing them again, and that they will be spared what Cameron says is the “disruptive” influence of politicians. He had in mind the Blairite supply-side reforms, which tried to force the NHS to open up to independent providers and force GPs to give parents the choice.
So who will run the NHS? Lansley has other plans, some of them quite good. But if he grants operational independence to the NHS elite, how will he enact these reforms? The NHS resisted Blair’s reforms when the Health Secretary had – in theory – dictatorial powers. How will the Tories reform when they have signed away those powers? By asking the NHS very nicely? Saying please, with sugar on top?
The ratio of manager-to-medic ratio in the NHS is one-to-one. That is to say, out of its 1.3m employees (more than the population of some EU member states) just 675,000 are professionally qualified clinical staff (details here). The rest are on the pen pushing/managerial/administrative side of the divide. The average NHS worker takes two weeks off sick every year, in addition to six weeks holiday.
The bureaucratic empire needs to be broken up; power needs to be transferred from the managers to the patient. This is the mission – Milburn was doing it. The Tories have told the bureaucratic elite that they will now have formal independence.
Once, the Tories had a good health policy: the “patient passport” proposed at the last election. A mini voucher system – the same idea that David Cameron is proposing for education. This would have put rocket boosters on the emergence of the Independent Treatment Centres, allowing any NHS patient to choose regardless of whether they were on a shortlist drawn up by their GPs. This would have transferred power to the users – exactly what the Tories are seeking to do in education. But when Cameron was elected leader, he adopted Labour’s sectarian attack language and described the passport policy as “allowing a few to opt out”.
My point, Coffee Housers, is that the Tories are on the wrong side of a very important distinction on health. Either you side with the users of public services, or you cosy up to the producers. Milburn rejected the sectarian language that Cameron has adopted. Milburn saw the NHS as a means of paying for healthcare – not providing it. It would be impossible to “opt out”, as Cameron described it, if your operation was paid for by the NHS because private clinics are part of the system. My guess is that Cameron will, in office, realise his error (as Blair did, post-Dobson) and that the Milburn/Major internal market agenda will be picked up again.
It is so very odd that Tory plans for education are so admirable and potentially revolutionary, while the heath agenda is so reactionary. Cameron has evidently placed the NHS alongside Europe in the category of things he doesn’t want to have a battle about. Fair enough – but he can’t then have it said that the NHS will get better under the Tories.