NHS REFORM

I'm so glad to be living in Scotland and out the way of these unnecessary and wrong NHS reforms. It has, incidentally, been a very long time since there was, as Labour likes to say, one NATIONAL health service. Things have been very different in Scotland and England for a long time. In fact some of the resentment that fuelled the rise of the SNP derives from the last time the Conservatives were in power when unacceptable policies were imposed : poll tax, de-industrialisation, introduction of markets into the NHS. That's why the Tories still have only one seat in Scotland.


The current NHS reforms are hard to understand. Why are they doing it? David Cameron said that the NHS would be safe in their hands and that there would be no 'top-down re-organisation'.  While we are used to politicians telling lies, this is a breathtaking example of promising one thing to electors and then, once elected, of doing the opposite. Whatever else it is a gift to Labour. You can be sure that much will be made of it in the next general election campaign. And its the most important issue for many voters. I saw the NHS described as the closest we have in the UK to a state religion. For a PR professional the Prime Minister has a very uncertain touch.


So, why are they doing it? I think its in their DNA and its unfinished business. When the Thatcher government came to power in 1979, they did have a mandate to privatise and got busy on coal, steel, rail etc. They were then keen to extend this approach to the NHS but found that it was such a shambolic organisation in business information that there was no basis for either separating out elements of service (because everything was so integrated - generally regarded as a good thing) and because nothing was properly costed. No one, famously, could tell Ministers how much a hip replacement cost.


All of the re-organisations that have taken place in the intervening years have been attempts to resolve these structural  problems. The NHS is now divided up into business units. And everything is costed. But these changes have largely been to the detriment of the NHS. The rot set in early. When they found that they couldn't privatise in 1979 the then government started to prepare the NHS for a future privatisation. They commissioned Roy Griffiths, then the Chairman of Sainsburys, to report. He found an organisation without adequate information and cost systems and recommended the introduction on general management.  


I think Griffiths was probably correct and I don't agree with those who think his approach was to turn the NHS into a supermarket. The NHS in those days did need to modernise systems and management but the scale of the changes has gone far beyond anything Griffiths could have imagined. Part of the problem is that so many NHS managers are not really managers, they are at best administrators,  and the sub-divisions of NHS business units are so unwieldy that integration, once in the bloodflow of the NHS, is now a full-time demand on those administrators. Another problem is that anytime anything becomes an issue civil servants advise Ministers to introduce another role to determine policy, monitor implementation and interpret results i.e. someone just like them. That's why there are so many civil servant type roles in the modern NHS.


So, Conservatives always want to privatise. It's the Conservative way. And they are completing the work they were frustrated in back in 1979. They are completing Keith Joseph's dream.


Whatever you think of it, it will lose them the next General Election.