Update 1st Feb 2015. Vernon Bogdanor opines in the Times, 25th Jan 2015: Fragmented Britain needs a better way to vote – As class allegiances weaken and the divide between town and country grows, our system of first past the post increasingly misrepresents opinion and can no longer deliver a majority government, writes Vernon Bogdanor. Letters in reply is also of note. To read in full see below.
NHSreality has a duty to speak out about the politics of health, and which party has the best philosophy to help improve the UK Health system…. An American Website discusses the consequences of covert rationing.. but many of the arguments apply to the UK. NHSreality has already posted on the UK system of covert rationing, and the debate that needs to happen. Who will be the first party to re-invent a truly National Health Service?
There are several main advantages to the Liberal Democrat approach.
1. Proportional Representation (PR) (in any form) will give fewer sudden shifts/changes in direction in philosophy, and health would be less of a political football. The recent debate and referendum on PR was badly conducted. The discussion on restructuring of the democratic elements of the UK (English votes for English issues) and Scottish and Welsh Independence movements show us there is demand for change. But change that has weakened the largest mutual has already happened and the old NHS is no more….
2. PR will encourage less risk taking politicians. It will encourage more people to consider careers in politics, and more professionals and graduates are likely to take part. This will give a long term approach, debate and direction, which the public will become aware of.
3. PR means less media. The media re always against PR as they like more “news” and sudden changes make for more news. First past the post systems lead to sudden and sometimes unpredictable changes.
4. Liberal philosophy means as many decisions as possible should be delegated to the periphery. This could mean that in health the high volume low cost services might be rationed peripherally, and the high cost low volume services rationed centrally. To be “fair” on the expensive services such as cancer drugs, the Regional Health Services need to agree the same rules for rationing these treatments whatever the post-code. Because Regions are financially independent, this means they will need the ability to vary the former to protect the latter. The exclusion of services will cause distress, and can only be done fairly if there is warning. Unfortunately knee jerk responses to the financial issues are likely to occur after this election…. (co-payments for GP and A&E attendances?) without the debate which would have preceded such a move in a PR state.
None of the political parties has yet adopted the need to ration health care. The media and the press refer to the National Institute for Clinical Excellence (NICE) as the government’s rationing body, but the “R” word is not mentioned by the politicians or on the NICE website. NHSreality has offered interviews to Lib Dem politicians such as Kirsty Williams in Wales, but has never had a response. Unfortunately the Liberals will continue covert rationing.
What will the other parties do? They will all have to do something – and further re-organising is inevitable.
Conservatives will privatise as much as they can get away with, a process begun by Labour. The disadvantages are in education and long term provision of the services privatised. They will reduce management overhead. They will continue to ration covertly. My own MP Stephen Crabbe, has refused interview on the basis that the Welsh Assembly covers this, and fails to point out that he in Welsh Office minister and controls the budget.
Labour will continue to hark back to Aneurin Bevan, and the misguided belief that we can have “everything for everyone for ever”. They will continue covert rationing. They do however “vow to replace tuition fees with graduate tax” according to Sian Griffiths and James Lyons in The Sunday Times. This could be progressive and help inequalities.. as long as there were enough Medical Student and Nurse places for future needs… from every area of the country. They do seem to have a schizoid approach – lampooning NHS England whilst staying quiet on NHS Wales. (Tim Shipman in The Sunday Times says “Ed Milliband accused over Welsh NHS” and reports a letter from 105 patients saying “It is simply hypocrisy to call “crisis” in England, and then turn a blind eye to the more serious situation in Wales”.) I am still waiting to interview Paul Miller, my local Prospective Parliamentary candidate, and Ms Watson has also been invited. (Labour plans GP safety checks for older people – Update 30th Jan 2015! Will they clone GPs?)
The Scottish National, the Welsh National and the other smaller parties have all failed to speak out against covert rationing, and so we can presume they wish to continue. The Green party policy document is the clearest exposition of the differences in emphasis between treating populations (wins no votes) and treating individuals (wins votes). They do not address rationing, and therefore NHSreality assumes it will continue to be covert. Louise Bours for UKIP says ‘UKIP will ensure the NHS remains free at the point of delivery and need. A two tier national health system, where those with money can opt to pay for enhanced services will never be acceptable,’…. which means covert rationing.
No-one knows more about the state of the Health Services than John Appleby of the Kings Fund. A quote from him is revealing after the Question “Who has been the best and the worst health secretary in your lifetime?” His response: “Bevan was before my time, but surely the best; the first top-down organiser of the NHS. Its hard to pick a loser out of the subsequent 28 (re)organisers. (Hoping for the “Appleby paradox” BMJ 2015;350:h107 )
European Journal of Public Health 24th Jan 2014 : Political determinants of health – Virchow (‘Politics is nothing but medicine at a larger scale’ in The
Health is a political choice, and politics is a continuous struggle for power among competing interests. Looking at health through the lens of political determinants means analysing how different power constellations, institutions, processes, interests, and ideological positions affect health within different political systems and cultures and at different levels of governance. Bambra et al provide three arguments why health is political1: health is unevenly distributed, many health determinants are dependent on political action, and health is a critical dimension of human rights and citizenship.
Political action on poverty and global health inequalities was the key message given by the first alternative world health report in 2005,2 and it remains the focus of many civil society organisations in global health. In 2008, the final report of the Commission on Social Determinants of Health3 also concluded with the political message that health is shaped ultimately by factors such as “the distribution of money, power and resources at global, national and local levels”—all of which can be tackled only in sectors other than health…
I suspect in the long term PR systems will give greater population health than first past the post ones. As science advances, and expensive techniques are available only to the largest mutual, and there will be an appreciation that we destroyed the best tool we ever had. Who will be the first party to re-invent a truly National Health Service? None of the parties has yet been tempted to try to reverse the specialisation and concentration debate, and attempt to retain comprehensive services at peripheral DGHs – they know there are not enough staff and that those there are will not apply! And they all agree with free speech..
Update James Meikle and Patrick Wintour in The Guardian 19th Jan 2015: Lib Dems announce campaign for NHS to set ‘zero suicide’ goal – Labour also calls for more funds for child mental health as parties launch policies on so-called Blue Monday