When I look up a definition for the National Health Service, the most common definition is ‘the system of national medical services since 1948, financed mainly by taxation’. This seems a fair enough explanation. Medical services, free at the point of need, financed by taxation. Nowhere do I read ‘a system where these services have to be provided by the service itself’.
I recently asked a question in the House about the Green Investment Bank and drew attention to the fact that ‘Historically, whatever services the Government decide to offer, the private sector tends to withdraw from, so what steps is the Secretary of State taking to ensure that the Green Investment Bank complements private sector investment in green technologies and does not merely replace it?’
One of the examples I could draw upon for this historical comparison is the National Health Service. As the NHS has provided for medical needs, many voluntary or charity run organisations have been edged out. This has stored up problems which are only now beginning to surface, for example, the NHS finds end of life and social care provision challenging, to the point that I have charitable organisations around my constituency that campaign for, and help to provide, hospice and palliative care provision as the NHS struggles to cope.
I do not agree with the ideological argument that the NHS itself should provide all the health care if a not-for-profit or indeed a profit making provider can provide a service cheaper, more effectively and to a high standard. The NHS should be concerned about outcomes not providers. Only one third of Germany’s hospitals are state run with the other two thirds run by either profit-making or not-for-profit organisations. The result is health outcomes far in excess of our own here in the UK.
In seeking to bar competition, those opposed to these changes have obviously not learnt from the failed political regimes of the Soviet Union. Ask yourself why numerous studies have shown that the UK’s cancer survival rates lag behind so many of our industrialised neighbours. According to research at the OECD, despite Labour's spending splurge, Britain still has the eighth worst record for preventable deaths among all its members – right down there with Mexico, Poland, and the Czech Republic. We have the seventh highest potential for efficiency gains in our healthcare system, which means the potential for better patient outcomes without spending more money.
The kind of NHS proposed by those opposed to this Bill would be one which would stifle innovation. We need to overcome the ideological stubbornness that says services must be both provided and paid for by the state. In 2004 the last Labour Government stunned GPs by the terms offered to them when negotiating their new contract that they thought it was a "bit of a laugh", according to one of the BMA’s negotiators. This effectively paid them more to do less and saw nine out of ten practices opted out of providing out of hours care and saw hospital A&E departments reporting an increase in patients. The same Labour Government gave contracts to NHS dentists which were so harsh that many of then moved wholly to the private sector leaving many patients with no choice but to pay for their dental care privately or travel great distances to get treatment.
Let’s analyse how the State has spent the Healthcare budget recently. In Labour's first eleven years, they increased health spending by 138%. But 43% of that disappeared immediately in pay deals and other cost increases, and the Office of National Statistics believes the volume of inputs only actually increased by 67%. Against that, the volume of outputs only increased by 55%. So excluding those mooted quality improvements, productivity fell by 7%, or 0.7% per aannum.
At a time when healthcare spending increases are going to have to fall, how can a system with that record of inefficiency be allowed to continue unreformed?
There is an intractable problem that health care inflation is running far ahead of inflationary pressures elsewhere. We read every week about new drugs that prolong life, these need to be paid for. Without strengthening the clarity between commissioning and provision, we will never see the efficiency in outputs that the injection of money should have achieved. The scrapping of inefficient Primary Care Trusts, Strategic Health Authorities and other various quangos will reduce management costs by 45%. Putting this back into care together with the introduction of competition and the opening up healthcare markets to innovative and efficient providers can only be good for patients and taxpayers.
This greater scrutiny of NHS providers would also help prevent another Maidstone or Stafford Hospital scandal where NHS secrecy allowed a massive medical failure to go unchecked.
Concerns must be addressed though.
People must feel safe in the knowledge that these reforms will not change the NHS from being free at the point of need, and secondly, that standards will be set high for both NHS treatments and for new providers, requiring absolute confidence in the regulator.
Thirdly, there are obvious concerns that employees of Primary Care Trusts will simply switch to GP consortia and pick up a fat redundancy payment in the meantime. We should seek to legislate that for those who switch organisation, should not be entitled to taxpayer funded payoffs.
Fourthly, and this is a part of the Bill which has not attracted much attention, I welcome the introduction of Local Directors of Public Health provided by local Councils. I read recently of how the Government was unfreezing marketing budgets due to a fall in users of stop smoking, obesity and other similar websites. It is my belief that local public health directors would be in a better position to drive these campaigns as it is they who can see what particular health problems a local area has.
In conclusion I feel that if we fail to go through with these reforms, we are caving into the Stalinist protectionist elements that have been allowed to stifle innovation and competition in our Healthcare system. This has perpetuated the poorer health outcomes compared to our neighbours that the UK is faced with. There is of course scope for improvement to the Bill but its defining characteristics must be left in place, the removal of inefficient bureaucracy and more patient choice whilst remaining free at the point of need.