Tory health policy is confused and contradictory: so why do they want to talk about it?

I don’t know why the Conservatives released their NHS manifesto yesterday. Can they really want people to read it? Do they think that’s a good idea? I’m not sure it is, you know.

Granted, there’s the promise of a free health pony to every sick kid in the country and plenty of nice-sounding stuff about decentralisation and patients’ rights and accountability and all the rest of it. But there’s also, as I suppose might be expected, an awful lot of “we will” and very little “this is how we will” accomplish all these goals. For instance: “We will give people access to a doctor or nurse when the local family doctor’s surgery isn’t open:. Sounds useful! But how are you going to do this? And doesn’t requiring this – and dozens of other reforms – actually demonstrate the extent to which top-down planning and the setting of targets will continue to be the rule, not the exception?

Some of those plans and targets might well be sensible but they do rather contradict the idea of local control. Then there’s a certain slipperiness about much of the document. For example:

British patients should be among the first in the world to use effective treatments, but under Labour they are among the last. The current system lets Ministers off the hook by blaming decisions on unaccountable bureaucrats in NICE, the agency which approves drugs for the NHS. We will reform the way drug companies are paid for NHS medicines so that any cost-effective treatment can be made available through the NHS, with drug providers paid according to the value of their new treatments.

The best one can say about this is that it’s total gibberish. You could be forgiven for thinking, having read this, that decisions on drug availability will henceforth be made by the Secretary of State for Health, not “unaccountable bureaucrats” at NICE. Is that going to happen? Of course not. Everyone always wants to “reform” the way the drug companies are paid (are the Tories really hostile to Big Pharma?), almost no-one ever succeeds. Still, that’s not all: note the casual, but vital, use of the words “cost-effective treatment” – in other words there will still, rightly, be rationing and not very drug in the world will be available on the NHS.

So, the Tory policy on drug availability and rationing is, as best I can see, pretty much exactly the same as Labour’s except that the Tories, dishonestly, try to pretend that there’ll be no such rationing in the future because those heartless experts bureaucrats at NICE will be over-ruled by ministers. Except, of course, they won’t. Because that would be daft. And politically inept.

You could easily and reasonably dismiss this as standard political chicanery but the heart really sinks when you read this:

With less political interference in the NHS, we will turn the Department of Health into a Department of Public Health so that the prevention of illness gets the attention from government it needs.

OK! Less political interference in the NHS? Does this mean Tory ministers will say that any given problem in the service is not, in fact, their problem? Will they take a hands-off approach to the NHS? I rather doubt it and expect you to doubt it too.

Worse than that however is this “Department of Public Health” nonsense. You know what that means: endless lectures about smoking and boozing and eating chips and all the rest of it. And it means that far from Nanny retreating, she will be empowered (to use one of the ghastly terms favoured by political consultants) by a Conservative government. All this will be justified on the absurd If it saves just one life notion and because, of course, the government needs to control lifestyles to control health costs. (Never mind that smokers actually contribute hugely to the Exchequer or that a rational government would encourage people to smoke.)

The NHS may be government-run but it’s not paid for by the government: it’s paid for by taxpayers who have, in their wisdom, contracted out health care to the government. That doesn’t give the state either the right or responsibility for nannying the populace. And yet more such nannying is promised – not merely hoped for! – by the Tories. Verily, there’s not much difference between the parties here.

All of which reminds me of an iron law: the more familiar one is with a party’s manifesto the harder it is to support that party.