Health plan a timebomb that might backfire on Cameron


OPINION:Widely regarded as the United Kingdom’s single greatest institution, the National Health Service faces yet another set of reforms, writes MARK HENNESSY

SITTING IN a surgery in London talking to a frank GP, one quickly understands the need for reform of the United Kingdom’s National Health Service and its £100 billion-a-year budget.

The tales are legion. Procedures to remove sebaceous cysts by laser, for example, cost £350 in hospitals, while the GP’s own minor-surgery clinic will do the work for £130.

Hospitals are paid a £100 fee for deciding to pick certain types of drugs over others, yet frequently send the patient to a pharmacy to pick up the medicines. Nevertheless, they are paid the fee.

Meanwhile, one patient suffering from eczema visited a hospital 10 times last year for treatment. Each visit was billed as a first consultation, whereas nine of them should have cost less.

Tracking problems with such bills by one IT specialist saved a clinic £57,000 in just one month’s catalogue of referrals. Yet, clinics cannot complain too often lest they damage relations with hospitals.

Bizarrely, some clinics report that they are getting visits from NHS hospitals, bidding to become their “preferred referral” at the expense of other NHS hospitals.

Despite its successes, and there are many, the National Health Service needs better management – the question is whether it needs yet another round of reforms of its management structures.

Created after the second World War, the National Health Service is, in many ways, the unifying force in UK society and one that politicians reform at their peril.

Secretary of state for health Andrew Lansley is the latest to try, with reforms that were not part of the Conservative-Liberal Democrats programme – nor even in the Conservatives’ own election manifesto.

Through its passage in the Houses of Commons and Lords, his legislation has been amended over 1,000 times – mostly, it must be said, by the peers in the upper house.

The role for competition in health services has been reduced, while Lansley – if he survives in his job – will have to answer for the NHS in England to MPs, which was in doubt under the original draft.

Having prepared his plan for years, Lansley has been unable to explain it coherently to a public that has been distrustful in the past, and is becoming so again, of the Conservatives’ NHS credentials.

Before the May 2010 election, David Cameron worked hard to persuade the public that “the NHS is safe with us”, playing partly on his own experiences with his son, Ivan, who died in 2009.

Cameron’s strategy, backed with a national postering campaign and endless interviews, worked. He neutralised the Labour Party’s traditional opinion poll lead on the issue.

Today, however, Labour’s trust-rating is again higher and – despite difficulties it is experiencing in nearly every other area – it is ruthlessly exploiting Lansley’s difficulties.

Lansley’s logic is simple. GPs are best-placed to judge a patient’s needs. Therefore, they should be given control over up to £60 billion to dictate the treatment necessary.

Existing NHS institutions would not have first rights to patients; private hospitals, charities, or those run on a not-for-profit basis would all be able to tender for the business.

The plan is not without merit, since some of the existing practices in the NHS, despite its considerable successes, would not pass muster in a well-run corporation.

Under Labour, hospitals were set targets for everything, leading to improvements in waiting times, but also to a myriad of measures designed specifically to get around the rules.

In some cases, appointment lists are created to fulfil the targets but then they are cancelled until the need again arises to send in the next batch of figures when appointment numbers jump up once more.

Most, if not all, of the major medical organisations have come out against all, or part of, Lansley’s plans, leading him to argue that vested interests favour the status quo.

If it goes ahead, the Lansley plan will see doctors having to create a new administrative structure to deal with hospitals to replace the existing primary care trusts (PCTs). If so, many of the staff needed to run it will come from those very same trusts or from private companies already champing at the bit to get the business.

Many doctors see merit in the proposals, though most believe that they either could not handle the extra management load, or that they do not want to do so. Indeed, the opposition comes even from those who accept that they would earn more under Lansley’s regime, since billions in fees would circulate around the health service.

British GPs have done well over the last decade. In 2004, with Labour following Nye Bevan’s advice to overwhelm opposition by “stuffing their mouths with gold”, the party sent their pay soaring. It has stayed steady since. Currently, British GPs earn on average £105,000 a year, according to figures last year – pay weighted in favour of rural doctors, with those working in central London earning least.

Clinics are paid £52 a head to care for each patient on their books in central London, while the sum rises to £115 per head for each living in the countryside, where practices are smaller.

Meanwhile, Lansley is attacked for not dealing with one of the NHS’s fundamental flaws – the fact that too many people end up in hospital when they should be cared for at home.

Up to now, the secretary of state has been supported by younger Conservative MPs, more right-wing than previous intakes, who believe the NHS is not fit for purpose. However, some of them now worry – even if they believe that Lansley’s original and now much-amended ambitions are right – that he has set off a timebomb that will explode in Conservative hands.

Meanwhile, David Cameron, who has never been one to focus on the detail, rues having gone along with the reform-minded Lansley on the path to change the NHS in the first place.

Having come so far, however, the Conservative-Liberal Democrats coalition now cannot turn back, since it fears the political consequences of such a humiliating retreat.

In truth, reformed or not, the NHS will always have crises. With this reform, however, they will all be blamed on Cameron – even if the changes are not the cause of the trouble.

Mark Hennessy is London Editor