Saturday 11 February 2012

NHS - there may be a way out of this

Miliband told the chamber "Another area he is in a complete mess is his health plans."
"We all remember the PM touring round the country promising no more top-down reorganisation of the NHS… I'll tell him why he made promises that he broke: because he is completely shameless and he will say anything. However much he says he loves the NHS… the truth is that he's got the wrong values... He's been found out. We know all we need to know about this prime minister from the NHS, he's reckless... He's proved the oldest truth in politics... You can't trust the Tories with the NHS."

And that was PMQs from a year ago. David Cameron spent years and years trying to reassure the public that the horrid Tories didn't really hate the NHS. They loved it. If there was one area not to have even spoken about in public, this was it. Because the trust was a fragile as a newborn.

Very early on I said that no good could possibly come from a reorganisation of the NHS. Its such a vote loser. I urged the government to drop the bill. Readers here were pretty scathing of my suggestion. Demanding waste, inefficiency, bloated bureaucracy, self interest, huge costs and poor performance be tackled at once by the government

My arguments that the government had already too much on its plate, what with tackling a £35 billion defence black hole. A justice reorganisation. Tuition fees. Welfare and benefits caps. A completely new proposal for schools. Fundamental changes to the tax system. A localism bill. Public sector pensions. Private sector pensions. Union membership at taxpayers expense. A boundary election review. An Av referendum. The so far untackled, but pre election bombshell of provision for the elderly. The privatisation of a crumbling mails service. Council tax capping and many , many more.. any one of which could be a central plank for a reforming government.

And all this planned during the worst recession for 80 years. Without the money to ease change or buy out the vested interests. With minimum 5% cuts across all departments. With rising taxes and rising inflation. Rising borrowing and rising unemployment. Whilst students protest in the streets and looters smash up shops. With the Arab world breaking apart. And the Euro in almost terminal crisis.
And the usual terrorism and violence continuing on. While politicians are not forgiven for their expenses crimes. And phone hacking neuters a normally friendly press. And recession makes the country grow ever more socialist, demanding that all must have everything or all must have nothing. With an ongoing, unresolved world financial banking crisis in play.

All this.. and yet the government thought tackling the world's 7th biggest employer, {- just behind McDonald's who operate in 119 countries not just the one} in which almost every household knows someone or has someone working for the NHS {McDonalds has some 67,000 employees in the UK compared to the NHS' 1.4 million. or 1 in 25 of the population.}

Tackle the NHS ? Whilst in a liberal coalition? With no majority? During an Olympic year?
Are you stark staring raving mad?

No government should attempt a top down reorganisation without a lot of time, a lot of money and a large majority. And not in the first year either as its going to need people used to government office and media to even begin to move the behemoth.

I knew it couldn't just be me thinking this. And so its proved with even some Tory cabinet ministers demanding the government put a stop to it, for purely political reasons. They are acutely aware that they are handing the floundering Milibandwagon its next government kicking opportunity. Miliband has even got a slogan out. "Ban the Bill." Quite catchy. it'll be a ringtone next.

Naturally I agree with those rebel ministers.

Politics is the art of promoting the possible and avoiding showing the unpalatable in public.
This Bill will only become more toxic. I confess I don't know anymore of the details than can be read in the telegraph. Its not the details that matter. Its the politics. As Tim Montgomerie's explosive call for the Bill's end perfectly demonstrated. He calls Mr Cameron to choose two paths - The watering down one. Or the pushing on into the minefield one. Already Conservatives have turned on Tim and are manning the barricades against any stop to the bill. This is just politicians unable to face a very tricky 'retreat whilst in engagement with the enemy,' dreaded by Generals and Prime Ministers because of the inevitable casualties and morale loss such a manoeuvre brings.
The government has got itself into a mess. Possibly a fatal one.

But there is a clear strategy out of this. One that might even strengthen the PM, rather than weaken him, after the initial pain.

1. Agree to a second look at SOME of the proposals, as Mr Montgomerie suggests. Especially bringing in Liberal Peer Shirley Williams and possibly Lord Ashdown and others who feel a sense of having collaborated too much with the enemy. Make sure Clegg has some role too.

2. Agree that more cross party talks are necessary and invite Labour to share in those most likely to pass the Lords.Make Labour a part of it. If they won't join, great. Ask for their non existent solutions each time they criticise.

3. Lansley has to go. Quietly if possible. Bloodily if not possible. Now who to replace him with?
A lib dem would have my fellow conservative backbenches screaming in rage. But its such a smart move.
A liberal tackling health reform takes the Tory Toxicity charge away immediately. It reassures the public. It allows the doctor's and nurses medical boards and unions and government to begin again. Clean sheet. Who it actually is is the hard part. I propose..

Vince Cable!

Jim Hacker would have spotted the master stoke this really is. The most undeserved promotion in history. "But merited;thoroughly merited, my dear chap."
It removes a poor business secretary to a high profile place where the outcomes have already been decided and the political losses written off. It makes room for David Laws to come back in a role that may well suit him at business.

4. The reforms will have to be watered down. There is no alternative. But that doesn't matter. Pick the red lines. Two years of parliamentary time's worth, and sacrifice the rest under a rearguard of amendments and negotiations.

5. Whatever the outcome the Liberals will have had a major success. One that they can genuinely put on their leaflets. "We saved the NHS." It allows the Tories weak, Italian style allies, to get a victory and a purpose inside the coalition. It will gladden the activists hearts.

6. The conservatives gain too. "Listening" Dave is back. He can claim to just be doing what the public and professionals want. "Tough choices have to be made, and will be made! Let there be no illusions. But in light of some recent discussion with hardworkingdoctors'an'nurses and with the help of a cross party/ coalition group i feel we've really got something that will make the NHS even better than ..blah blah blah." You know the shtick. Sleeves rolled up. Tie and jacket off in a health centre somewhere. . no notes. He does it very well. Caring conservatives are back to help take the focus of all the other uncaring policies that have to be put into place.

7. The success of the NHS may just save the Liberals who have made so many stupid 'no top down reform' type pledges of their own over the years they don't deserve saving. But in practical, reality land, a coalition again is a very likely possibility.
If the Liberals feel they have genuinely achieved something. Have genuinely influenced Tory policy. Are a 'force for good' within the evil Tory galactic empire, then so much the better.

Labour are going to claim the reforms are a failure whatever happens to them anyway. Labour are irrelevant.

Let the baby have its bottle. Vince Cable for the mediating Health Secretary!

Meanwhile the government can get on in peace with its brimming over plate of other, even more difficult issues.

That shiny new 1960's hospital in the picture at the top is from Carry on Doctor. Its actually Maidstone Town Hall.

"Health Bill proposes turning hospitals into tax buildings!"

That's the sort of made-up headline Mr Miliband's people are just waiting to write, Dave.

For the next two years - one a day. Fed to the Guardian and BBC and injected into the nations psyche.

Can't say you haven't been warned.


Lord Blagger said...

Without the money to ease change or buy out the vested interests.


So pick on one vested interest. If they cause trouble, double the cuts. If they carry on make the cuts even bigger.

I would start with some quangos and complete abolishment.

Then you work your way down the list.

There should be three categories. Dead - possibles and keeps.

Deads go immediately. Overnight. Money cut off.

Lord Blagger said...

I agree. Give Vince the job. However, give him a reduced budget and let him get on with it. If he overspends, then he has to stand up next to Clegg and explain why nurses aren't paid and the NHS is A&E only.

He can also take the can for trusts that go bust.

Anonymous said...

An excellent and coherent argument about the need to tackle the possible - in your first part. Spoiled by anti-coalition ramblings in the second.

Hacker would have stopped the bill and set up a commission to kick the whole thing in 2016.

hatfield girl said...

Enviably first rate analysis.

Which political problem should be tackled first? The NHS and the state education system are great blocks of realised socialist central state planning, on a Soviet inefficiency scale, rooted in the UK economy.

You're right they can't be dealt with both at once. I'd have gone for the NHS first but having started with education the Conservatives would have done better to wait till the next government to deal with socialism's other left-behind forces.

Steven_L said...

Whenever I've used the NHS I've found it to be a bit over bureaucratic, but they do generally diagnose you properly and treat you.

If you look at cross country comparisons we spend less than most on healthcare. It's perfectly possible to make sensible, coherent arguments we should spend more.

So you're right, without a majority the government are mad to try a wholesale re-organisation. The public don't trust politicians of any stripe (quite rightly too) and this will be a political disaster.

A lot of tory ideas for the public sector are just fantasy. They reckon that trading standards officers are going to form themselves into nice little workers coops and bid in competition with each other for contracts from LA's.

It's a nonsense. Most LA's want to avoid local disputes so are laying off all their contractors and temps so as to avoid expensive compulsory redundancies of perms. Most LA workers like their flexible working and maternity arrangements and have no desire to leave the comfort of the cotton wool they are already wrapped in.

No council director wants these reforms. If any elected members pushes for it, then it's dead easy to get a quote from one of the temping agencies showing it is 50% more expensive to replace all the staff with contractors.

It's all CCHQ apparatchik pie-in-the-sky that has little concern for how things actually work in the real world basically.

Lord Blagger said...

Except that the NHS's own figures are they kill or contribute to the deaths of 20-80,000 patients a year.

Time I think to let the PR machine lose on their performance, and offering the alternative.

Steven_L said...

Well the stats in the table in my link show we're only second to the US for killing patients.

But point to any of the other countries on the list and they all spend more than us on healthcare.

The left will just bang on repeatedly about a lack of funding compared to other European countries "that invest more" and how the US model is worse and more expensive.

Then if they've got any sense they will bang on about 'prevention being better than cure' (rhetoric which doctors love) all call for "more investment" in touchy-feely outreach type stuff.

Lord Blagger said...

I've had direct contact and been their on one occasion where the NHS killed patients.

4 in total. It's wide spread. It's kept secret.

The primary change is that the three functions of supply, insurance and regulation need to be separated to ensure no conflict of interest

GSD said...

Just brilliant, BQ!

As you've shown here, there are some clever (almost inspirational) ideas floating around at Westminster. Why do they never, ever see the light of day?

Old BE said...

I don't like it, but I think you are right. My only criticism of your logic is that the reforms were *supposed* to be exactly the opposite of "top down reform". The idea was to devolve the decision mechanism to as close to the consumer as possible. A great idea and long overdue.

However as you point out, public goodwill has been squandered (unlike with welfare reform).

Tim Almond said...

The mistake here is to assume that public opinion is inflexible.

The public don't actually care about how the NHS is run, they care about what it delivers. Right now they oppose reform because they don't believe it will improve the NHS, but if they find that it does improve the NHS they'll soon change their minds about it.

And the benefits to the nation will be huge. Not only will it improve health, it will also be a springboard to further market reforms. It will make opposition to reforms of education much harder if the results of health reform give people better schools.

You can't work with Labour or the red liberals on this because they are completely opposed to markets in health. The health unions would lose most of their power and customers if we had private providers of hospitals.

So, Lansley and Cameron should be getting this bill implemented as quickly as possible, in order that people have as long as possible to see just how much better things can be before the next election.

Budgie said...

BQ, that is persuasive but ....

Where did you get the idea that Labour would not criticise the Tories over the NHS? That's what Labour does. And it is an easy target because the Tories are too lazy/incompetent to counter this propaganda.

Top-down cuts/reorganisations, that is literally imposed only from the top, will never work. You have to carry the organisation with you. And work closely with the people involved who in any case will know a lot more about the organisation than you do. Most politicians are far too arrogant to demean themselves in this way. So it fails.

Bill Quango MP said...

Lord Blagger: Oh yes. Give Vince a flat budget. See how he gets on.
If he succeeds he's a hero. if he fails .. he goes.Welcome to government.

Anon: Not coalition bashing {not too much} I quite like coalition.
I agree that a commission is a way out. But at present the government are determined to push ahead. Like those crusader knights who pushed across the desert, sure that they were heavily armoured enough to withstand the flights of light Saracen arrows. But the Saracens daily launched thousands of little arrows and by the time the knights got to Hattin they were too exhausted to fight the battle and were all killed.

HG: Thankyou: I would choose education every day. Its an easier tackle as the money is allocated, the schools are built, the teachers trained. Mr Young is blazing a path that the big state cannot abide. In my are over 3/4 of primary schools are in the top 25% of the league tables. The secondary schools are all in the bottom half. It takes no genius to realise that if the same capable children from the primary suddenly become dim witted thugs then the teaching and teachers themselves are to blame/praise.
Its as hard to tackle as NHS because everyone supports their local school. Even that school that was refusing academy status and just failed its ofstead causing the head to resign {rare}had parents and placards at the gates.

How to tackle schools is as difficult as health. Don't do both at once.

Steven_L : I like the NHS. For a bureaucratic state institution it does better than many, worldwide. On my office straw poll we discovered
1. All want a local hospital.none want to travel
2. Over half think all hospitals should perform all operations {surprised me that one.}
3. Waiting times at A+E are too long
4. Car parking charges are obscene and should be reduced massively.
5. Most people's own care was very good.
6. Most people's relatives care {especially old people} was very poor at the basic clean/eat/help level.

I expect the Tories could make major improvements for little cost without a major health bill passing parliament.
La's are making a right mess of it too. How come these super executives on mega pots of cash don't know the law? Any middle management executive from the private sector could tell them the procedure and the law for dealing with redundancies and closures and contracts.
Yet I read that no thought was taken to future library provision even though its a statutory duty to maintain them. Expensive legal cases lost. Incorrect information given to employees -legal cases brought again. Chief executives on £250k for not properly running the council? And people bleat about MP's paltry 100K!

Bill Quango MP said...

LB/Sl - I think patients deaths are a part of medical care. We know that many people die from infection and misdiagnosis. But many hospitals overdiagnose and investigate in a way that private medicine couldn't. I remember being in hospital after a high fall and having back, brain, arm leg scans. Old fashioned X-rays. drips. Shock treatment. Deep eye examinations. Ribs, feet etc and a whole load of drugs before they decided I had deep bruising.
{all those tests and they still missed a piece of glass the same size and thickness as the bottom of a jam jar buried in my hip.}

A man next to me was about 80 and they were giving him drug and operation after operation. In what other country would they bother? How much longer could he live? I would not wish to not have free health care or free schools. i just don't believe they must be state monopolies.

GSD. Thankyou. cabinet treats backbenchers as they do twitter. Just switch it on to see what all the day's fuss is about and then turn it off again.

BE: On BBC Dateline last night a panel of 5 left wingers {if there were any right wingers they were very quiet} did the stories.
NHS..NHS..NHS and made some incredible claims about privatisation, broken promises and the despair of clinicians.
The fact that this is basically labour's ideas and the liberals too is already buried. No good can come from it now. They very best outcome would be if everything went well and no vote were lost. Hardly council house sales is it?
{which, BTW are very much on the agenda. Expect a gov announcement soon}

The very worst thing that has started appearing and was mentioned on that show was 'this is a poll tax moment.' isn't. But there is only a limited time for a climbdown. Then these things have their own momentum.

Brown invested the entire store of his meagre political capital in a bill on 42 days detention. he had to bribe unionists with airports and his own people with special favours, bills and jobs.
He won the vote only for it to be defeated in the lords, as he knew it would be.
What was it even about? Nothing at all but obstinacy.
I thought Dave a shrewder operator than Incapability Brown.

The Stigler:Welcome. Public opinion is indeed flexible. But health is already facing cuts.
If these reforms go ahead it is easy for Mr Miliband to claim that a patient who slipped on a puddle in a ward has been a victim of 'Cameron's Cuts.' That anyone who is given the wrong drugs is a victim of 'Lansley's Lunacy.'

Labour spent seven years trying to remove the government from health cockups. Tony Blair didn't like being blamed by Sharon Storer for her husband's poor cancer treatment.So he arranged for trusts to be a buffer. It would be folly to take back that sort of ownership.

Budgie: I only suggest that labour are invited. I don't expect them to attend or contribute. That leaves them pursuing their own plans away from 'the grand coalition health commission' under Saint Vince.
Makes it harder for them to carp.

And labour will oppose. They have spent a year opposing their own reforms on finance and health already.

They are going to take aim at the Health Bill and health secretary no matter what, No point giving them hollow point ammunition.

Bill Quango MP said...

And the argument I made a year ago still stands.

Obama already tried this and it almost cost him his Presidency. And he had far more reasons than us to reform his nation's healthcare.

Obama, the most popular president since Reagan. darling of world statesmen and women. Media gliterrati and left wing pin up threw away a 40% lead battling healthcare and not focusing on the economy.

And even now that quagmire keeps sucking his shoes.

Medical insurance premiums in the United States are on the rise, the chief architect of President Barack Obama’s health care overhaul has told The Daily Caller.

Massachusetts Institute of Technology economist Jonathan Gruber, who also devised former Massachusetts Gov. Mitt Romney’s statewide health care reforms, is backtracking on an analysis he provided the White House in support of the 2010 Affordable Care Act, informing officials in three states that the price of insurance premiums will dramatically increase under the reforms.

Electro-Kevin said...
This comment has been removed by the author.
Electro-Kevin said...

Couldn't they have settled for now with bringing back matron and cutting down on managers.

Also bringing GPs back into line to make sure they work weekends and nights.

Cost saving and popular.

How could the Tories fuck it up ?

dearieme said...

"Very early on I said that no good could possibly come from a reorganisation of the NHS. Its such a vote loser." I agree. I see all too much of the NHS and its intrinsic incompetence, but feel that dramatic change is not the way to go, at least not now. Slow, steady, marginal improvement is the best that could be done at the mo'.

Peter Whale said...

There is a very simple and no cost way of improving the NHS and the education system. Every public servant from The prime minister down must use the NHS and the state school system for themselves and their families, this applies to local government as well, this is mandatory and if they want to use the private system they must relinquish their role in the public system. After all they run the systems.

dearieme said...

Blair used the state school system: but of course he worked it so that his children attended a very untypical state school and then hired tutors from Westminster to give them some afterhours coaching. That sort of behaviour is what you want, is it?

Peter Whale said...

Blair was one person put the whole civil service and local government in that position and you would see a very quick change in the NHS and education.
The other reform I would like to see is everyone gets the same state pension. No company schemes no civil service schemes. If you want to top up your pension you do it privately out of earned income.

James Higham said...

The privatisation of a crumbling mails service. Council tax capping and many , many more.. any one of which could be a central plank for a reforming government.

And all this planned during the worst recession for 80 years. Without the money to ease change or buy out the vested interests. With minimum 5% cuts across all departments. With rising taxes and rising inflation. Rising borrowing and rising unemployment. Whilst students protest in the streets and looters smash up shops. With the Arab world breaking apart. And the Euro in almost terminal crisis.
And the usual terrorism and violence continuing on.

So, all in all, a good time to be alive, Bill?

Bill Quango MP said...

JH:Review of 2011. "Not much happened really. Except all the events for the decade decided to rush into 2011 just to get them out the way. 2012 looks to contain even more."