Health policy debate
4 to 15 November 2005
Politics
Is Tony Blair in a position to drive public sector reform?
Some argue that following his first parliamentary defeat, Tony Blair is not in a strong position to drive through further market reform. Following Sir Christopher Meyer’s recent book, in which he compares the current administration with the final days of the Major government and Michael Howard’s jibe that Blair is in office but not power, political observers have been debating the strength of the prime minister’s position.
The Economist noted that ‘Mr Blair’s legislative programme seems almost calculated to irk his party rebels’. While The Economist believe the use of markets and enterprise in public services is ‘sensible and desirable’, they note it will not appeal to backbenchers, ‘especially if Mr Blair sets out to confront them in repeated trials of strength’ [go to note 2].
Some estimates claimed there are as many as 80 rebels waiting to defeat the government on health and education reform [go to note 3]. Martin Kettle, writing in The Guardian, says they are united by not knowing what they are for. ‘Their chief wish seems to be for nothing much to happen, in the hope that Brown may magically remove the need to engage with touch decisions about the modern world.
The Guardian’s Michael White recently interviewed Blair but doesn’t think he is finished yet. ‘I was impressed as ever by his strategic political grip’. ‘My conclusion is that he thinks roughly this: that his self-imposed timetable in office is running out and that he regrets listening to other people’s past caution too often. From here on he will push his luck to the outer limits on public service reform, until he succeeds or is topped by MPs, judges, or the unavoidable facts of life’.
White says, ‘reform of the primary care sector is entering a critical phase in parallel with the hospital sector with its payment by results and full patient choice in place by late 2006. Mr Blair was up to speed on that too. It has to happen, he says [go to note 4].
Patricia Hewitt articulates ambitions for 24/7 primary healthcare, but softens the stance on private involvement in primary healthcare
In a speech to the NHS Alliance, Patricia Hewitt signalled her intention to improve access to primary healthcare, but was apologetic about the publication of plans in late July. “Clearly we were too prescriptive”.
While she talked about private sector involvement, this was limited to areas where there was little scope to increase capacity any other way. Instead her emphasis was on entrepreneurial GPs and nurse practitioners expanding into new areas to improve services [go to note 5].
What effect did Hewitt’s contrition and more clearly stated ambitions for health have on MPs?
While the Lib Dems were critical about how Hewitt’s ambitions could be fulfilled [go to note 6], Roy Hattersley wrote a surprisingly supportive article on the primary care reforms. He said Hewitt’s policy ‘offers a special bonus to Labour MPs who are looking for consensus rather than confrontation’.
‘… people like me - who know that the "choice agenda" will usually penalise already disadvantaged families - can welcome this particular mixture of private and public provision in the knowledge that, unlike some of the schemes for grafting the market on to the social services, it will provide real help for the old and the sick who now struggle to make appointments at inner-city surgeries’.
‘There is a minority of party members who will react against the proposal simply on the grounds that the words "private" and "health service" should never appear in the same sentence. They only harm the cause they claim to champion. There are, without doubt, great swaths of medical care in which the providers should be motivated by the public-sector ethos rather than by the incentives of commercial enterprise. But it is hard to imagine what damage would be done by the employment of general practitioners who are paid in a different way from the regulation health service GPs. They sell their labour, as individual contractors, to primary care trusts. Aneurin Bevan tried, and failed, to make family doctors employees of the state. A rebellion over an amended form of self-employment would be no more sensible than a war about which end of a boiled egg should be cracked open’
‘Patricia Hewitt smoothed the passage of her reforms by "apologising" for what she described as her "too prescriptive" insistence that primary care trusts must contract out their district nursing and family-planning clinics. That was a sign of self-confidence as well as of grace and deserves a warm welcome. …‘Patricia Hewitt's proposals represent one of the few occasions in which New Labour's talk about the need for tough decisions has evolved into a proposal which challenges the privileges of a vested interest. They put Labour on the side of the patient' [go to note 7].
Conservatives force debate on financial management in the NHS
Conservative Party research, undertaken in advance of a commons debate on November 15th, gathered figures on financial debt from SHAs which were at odds with the recently published audited debt.
The audited debt of the NHS was £536,527 million, but the projected debt based on these figures is £996,690 million, almost double the audited amount. As the Telegraph noted, ‘normally the projected deficit turns out to be less at the year’s end. Nevertheless, the trusts are predicting that the deficit in March next year will be bigger than the deficit at the end of the last financial year’ [go to note 8].
The Sun noted that Lansley’s research revealed 92 community hospitals are under threat. They ‘face closure or being substantially scaled back’ [go to
note 9].
The Telegraph pointed out that, ‘official figures show that the cost of bureaucracy leapt by £1.3bn between 2000 and last year’. Andrew Lansley, the shadow health secretary said,”the similarity between the projected deficit and the cost of extra administrative staff was no coincidence. “Too much is wasted on bureaucracy”.
A Telegraph leader lambasted financial management and productivity in the NHS. ‘How on earth does the NHS, which is already awash with case, manage to overspend by such a prodigious sum?’ ‘Not only has the NHS-back office expanded hugely, but all staff have enjoyed pay awards far above inflation. This is part of the wider problem that afflicts a government which spends without reforming: the job expands to full the resources available’. It said, ‘We cannot continue to fund out of general taxation a health service whose structures inhibit financial prudence’ [go to note 10].