Posted on 09/01/2007 4:08:10 PM PDT by GeorgeKant
Mr Brown will find it hard to regain the commanding heights on health
FOR a chancellor of the exchequer turned prime minister, the irony must be galling. The National Health Service has dominated voters' concerns during the decade that Labour has been in power. Responding to these worries when he was at the Treasury, Gordon Brown sanctioned budget-busting increases in spending on health. Yet as the public became increasingly disenchanted with the government's handling of the NHS and more pessimistic about its prospects, Labour squandered its huge historic lead as the party most trusted to run the health service.
The publicly funded NHS is an iconic institution for Labour, which brought it into being after the second world war. After trying to make it work better by imposing tough targets, Tony Blair, as prime minister, increasingly stressed the need to unleash competitive pressures within the NHS, an approach that violated traditional Labour values. Mr Brown, by contrast, expressed scepticism that the health service was the right place to look for invisible hands, and this led to speculation that, once in the top job, he might seek to reverse or slow his predecessor's reforms.
In a surprise move, Mr Brown instead simply changed the subject, highlighting new priorities such as housing when he set out his political stall in early July. He also played for time, asking Sir Ara Darzi, a prominent surgeon whom he had made a health minister, to work out how the NHS should develop over the next decade. Sir Ara, now Lord Darzi, will issue an interim report in a few weeks' time; his final report is due by June 2008.
The political tactic of preparing the ground by commissioning a friendly forward-looking review worked rather well for Mr Brown at the Treasury. Casting a problem forward helped deflect awkward questions about what Labour had actually achieved in office. But if the prime minister thought this technique would be enough to reverse Labour's slide on the NHS, a poll by ICM published on August 27th in the Guardian will have been a rude awakening. It found that 44% of the public thought the NHS was likely to deteriorate under Labour, compared with only 35% who thought it would head downhill under the Conservatives, a margin of 9%.
This means that Mr Brown will soon have to come up with new remedies for the NHS. Despite his lack of enthusiasm when he was chancellor for encouraging market pressures within the health service, he now looks set to carry forward the broad thrust of Mr Blair's reforms. The programme to step up private provision of hospital care financed by the NHS may be trimmed, but the strategy of more patient choice and greater competition within the health service will continue.
Even if he sticks to the same general strategy, Mr Brown needs to tackle some of the specific reasons why the public has become so critical of the government's performance on health. Crucial among these is a belief that Labour has simply mismanaged the NHS. After the general election in 2005 big deficits emerged in many parts of the health service, although it had received lashings of taxpayers' money. The retrenchment needed to deal with these financial difficulties hurt not just patient care but also Labour's reputation.
This perceived incompetence was exemplified by a flawed attempt to change NHS recruitment practices. It went so wrong that emergency steps had to be taken to match junior doctors with hospital training places this summer. A review group chaired by Neil Douglas, vice-chairman of the Academy of Medical Royal Colleges, recently concluded that this botched shake-up “sparked the biggest crisis within the medical profession in a generation”.
In fighting to restore faith in Labour's ability to run the health service, Mr Brown has named a fresh team, led by Alan Johnson. The new health secretary has one big thing going for him: the NHS as a whole has swung back into surplus. Mr Johnson, an emollient former trade unionist, has been able to rustle up sufficient money to sweeten this year's pay deal, which should avert a threatened strike by NHS staff.
But health-service funding will tighten next year. For the best part of a decade NHS spending has risen by around 7% a year in real terms. Sustaining such a pace is unaffordable and the new spending settlement to be announced in October is likely to halve that growth rate. This is still generous, compared with what other public services will receive, but after so many fat years it will feel like famine for the NHS.
With money tight, Mr Brown's main strategy for retrieving Labour's reputation on health care will be to try to regain the trust of doctors and nurses, who have been upset and infuriated by the “command-and-control” regime of targets and admonitions. Low morale among medical staff is a problem not just for the NHS but also for Labour. As Ben Page, a pollster at Ipsos MORI, points out, the views of trusted health-service professionals matter hugely. If the doctors are badmouthing the NHS, it is difficult for the government to counter their criticism.
Lord Darzi's review provides a way for Labour to rebuild bridges with the medical profession. One of the main tasks he has been set is to work with the doctors “to ensure that clinical decision-making is at the heart of the future of the NHS”. But Lord Darzi could still ruffle a few medical feathers. A report that he conducted for London's NHS suggested moving relatively simple hospital treatments into cheaper “polyclinics”, which would form a halfway house between a family-doctor practice and a hospital. Neither general practitioners nor hospital consultants are likely to be keen on this innovation if it features prominently in his national review.
Under Mr Brown, policy towards the NHS will thus combine continuity and change. The main reforms introduced by Mr Blair will remain intact but there will be a rapprochement with clinicians. The package may wrest back some of the lost ground, but, despite all its largesse, Labour is unlikely to regain the commanding heights it once occupied as the undisputed party of the NHS.
The way to kill the NHS is to permit it to die by comparison.
The Canadians might already be trying this, introducing a few elements of capitalism around the edges, perhaps hoping that over time, the obvious efficiency of the free market will reduce socialized medicine to the equivalent of indigent health care in the US.
It was created with ten thousand incremental steps; the way to kill it with the least embarrassment is a death by a thousand cuts.
But let me reiterate, the way you stop socialized medicine in the US is NOT by pointing out its failures elsewhere, because this means nothing to the true believers of the religion of socialism. What America must do is to systematically eliminate those inefficient elements of socialized medicine that have already been sneaked into our health care system.
Don’t just hold that line, counterattack. Just by eliminating the socialism already in place, the American health care system will improve in efficiency and affordability.
By comparison to what? I say let it die by competition.
I believe that Newt Gingrich is working in that direction, particularly in his recent scathing indictment of failed Detroit city government and particularly its union and schools. It's also an indictment in general of governance and fiscal politics in other big cities, most of which are run by Democrats.
Even if some things are financed by the government, they should not be run or heavily regulated by government - that would be only the first step in reversing socialized "anything" in US. Choice of better service and / or lower costs due to competition in private sector will slow down and later stop the society's "socialist disease".
"To cure the British disease with socialism was like trying to cure leukaemia with leeches" - Margaret Thatcher.
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