Libya, Japan, Bahrain: the past few weeks have been about as funny as a lock-in with Gordon Brown and Gaddafi. In a year marred by blood-shed and natural disasters, subjects for satire have been, somewhat unsurprisingly, thin on the ground. Yet in this chaotic global climate it is more important than ever to rescue the absurd from the awful.
A quick glance over the papers doesn’t bode well though: Japan continues to be hit by everything bar a Biblical plague, whilst Colonel Crackpot Gaddafi has stepped up his pan-Atlantic crazy-off with Sheen-dog and Mel Gibson. Bleak reading indeed. At least it was until Conservative MP and former GP Sarah Wollaston – lauded by The Telegraph as Cameron’s ideal MP just 18 months ago – laid siege to the health reforms.
Wollaston’s lambasting of the bill – likening them to lobbing a “grenade” into the NHS and labelling them “doomed to fail”– essentially tomahawked already fragile ConDem proposals in the foot. The reforms will see the allocation of £80bn of the NHS’ £100bn budget to new GP-led consortia and, as Cameron proudly proclaimed, the “abolishing of the bureaucracy of the NHS”. Yet after a week which saw Ed Miliband unprecedentedly better David Cameron in PMQs and revelations of health secretary Andrew Lansley suppressing reports revealing current record-high levels of satisfaction with the NHS, Wollaston’s article could prove the sack of bricks that breaks the camel’s back.
So what is the problem? Well, as Miliband explained, the reforms would remove the sector-specific status the NHS currently enjoys and open it up to EU competition law alongside all other sectors. This means that GPs would have to tender contracts out first for fear of anti-competition prosecution from private corporations instead of turning to local hospitals, prompting widespread fears that large private corporations would undercut NHS providers, crippling local units and compromising care quality for cost. Such a compromise would, according to Wollaston, also threaten the NHS’ core structure: “this vast organisation can[not] be managed by a commissioning board in London with nothing in between it and several hundred inexperienced commissioning consortia”. Indeed, while the government insists it will put “doctors in the driving seat”, the bill will still allow the Health Secretary to impose any conditions upon consortia without consultation – despite Simon Burns’ insistence about reducing “the discretion of ministers to interfere in the NHS”. Such a reduction will clearly have to wait then until after the bill has been forced through – at “the discretion of ministers”.
Yet it is crucial to remember that the bill promises substantial savings – right?
Well, not necessarily. In reality, the reforms offer short term dividends offset by long term losses as the NHS struggles to maintain service levels and simultaneously save billions, effectively gravitating towards an American style privatised healthcare system so that Cameron can wage war on those pesky “bureaucrats”. And therein lies the problem: Cameron’s dogma that “bureaucrats” are the “enemies of private enterprise” and progress. The PM – cape fluttering in the wind – has vowed to fight those “bureaucrats in government departments who concoct ridiculous regulations that make life impossible for small firms”. Or, as they would argue, those bureaucrats who simply enforce, albeit officiously sometimes, government-imposed regulations, and without whom there would be no ‘Big Society’ or other The Thick of It-esque policies. It is one thing to attack bureaucrats – now little more than a byword for inefficacy – but it is another to abolish the necessary mechanisms for running an institution. For while the bill’s proponents assert GPs’ desire to get more involved in high-level decision making, it is crucial to distinguish the difference between on one hand directing care quality, and on the other hitting fiscal targets set by an economic regulator (Monitor) that renders “top-down government organisation” a proverbially tepid frying pan. Cameron may be bent on “abolishing the bureaucracy of the NHS” but this is a pyrrhic victory if private management and consultancy firms replace it soon after at astronomically higher costs. And the irony will not be lost on those “distant bureaucrats” either when their redundancy packages are followed by an offer to oversee, say, a GP consortium or healthcare consultancy firm…
And while the PM may dismiss the BMA as a disgruntled labour union, it will be harder for him to ignore the Nuffield trust report, noting that it would take “exceptionally skilled and focused management” to maintain the current operating levels of the NHS – most likely not the kind doctors would be willing/qualified to provide – whilst simultaneously cutting £15-20bn: “a mammoth task”. Moreover, another report questioning 800 GPs found that less than 25% believed the reforms would improve care quality, with many voicing concerns over the impacts on local hospitals. And should the Conservalition seek precedent to support the bill then the outsourcing of NHS cleaning contracts or the unmitigated failure of Railtrack – the crowning jewel of Tory privatisation – should suffice.
With Cameron working overtime to lump all of “Broken Britain’s” problems on the “bureaucrats” and Andrew Lansley busy giving public healthcare a buggering it won’t soon forget, rumours of Jamie Oliver opening his own ‘Dream NHS’ starring the cast of Scrubs and Grey’s Anatomy are yet to be confirmed by ministers. If this prospect leaves you despairing though, then take heart in Agony Aunt Clare Rayner’s dying words: “Tell David Cameron that if he screws up my beloved NHS I’ll come back and bloody haunt him”. Here’s hoping…