Monday, 21 March 2011

Educating the health secretary

While the battle to protect Libyans from Gaddafi continues, domestic news - bar, perhaps, this week's Budget - is unlikely to get much of a look in. But the weekend saw two further dents in the credibility of Andrew Lansley's grand plans for the NHS. First, the Observer revealed that recent polling showed record levels of satisfaction with the health service, after the reforms and investment of Labour. This information had been suppressed by the Government, which talks a lot about publishing facts but tends only to do so when the facts suit their case. In this case, Lansley apparently preferred 2006 data to more recent figures. The figures bore out the findings of earlier concerns about the government deliberately ignoring an improving trend in health outcomes. Both are shamefully promoted by Lansley. But we need to know the baseline, and trend, so we can judge his changes in the same light.

The second dent came in an article by the independent-minded GP and Tory MP Sarah Wollaston, in the Sunday Telegraph. She is particularly concerned about the impact that stripping out Primary Care Trusts and handing £80 billion of public money to GPs will have on the NHS. There should be as much concern about the premature removal of floor standards over waiting times, which are likely as budget cuts bite to lead to longer waits for treatment and a return to the trolley patients of the late 90s. As I have argued before, the issue is not whether reform is needed or even whether GPs can be entrusted with primary care budgets, but the utterly mad way in which these reforms are being introduced. There is no evidence they will work: it is all based on a hunch, which might be OK with a £5 bet at Cheltenham but not with an £80bn wager on the NHS. There is no distinction made between enthusiastic GP fundholders and unwilling conscripts. There is no proper transition with targets and primary care trusts. The whole thing has failure written all over it in large letters, and it is astonishing that neither David Cameron nor Nick Clegg can see it.

The absence of any proper No 10 policy scrutiny is evident in the way these changes are being introduced. And if the new policy wonks drafted in to the PM's Policy Unit have any sense they will immediately propose several changes to the Lansley lunacy. If they want a better model of reform, they could ask Michael Gove at education who has adopted this approach with academies and free schools. First, make fundholding a gradual process available to those who want it and have the skills to deliver it. Second, retain PCTs as a smaller but important strategic oversight until there is universal fundholding. Third, keep some floor standards - maximum waiting times for treatment and A&E - and use them as part of the accountability package. Fourth, be absolutely clear that competition will be on quality with fixed prices for treatment. That is the model that Gove has adopted in education - pace but choice on academies and free schools, residual local authorities, GCSE and Key Stage 2 floor targets and fixed per student funding (still linked to area) with adjustments for poverty and special needs (albeit with spending cuts). Lansley could do worse than learn from his education colleague. The rest of us could do a lot better if he did.

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