When gold won't buy quiet
From Mmc
Leader
Monday March 19, 2007
"I stuffed their mouths with gold," said Aneurin Bevan, recalling the only way in which he had been able to silence the shrill protests of the consultants who might otherwise have strangled the NHS at birth. After a weekend in which doctors took to the street in protest, ministers may take comfort from knowing that for the government to encounter resentment from medics is nothing new. But ministers may now face a deeper difficulty too, in the attitudes of taxpayers. Helped along by a Conservative party showing a new adeptness in presentation, the idea gaining ground is that the government has once again been dishing out the gold to the doctors, but that this time round it has not been having the effect it should.
David Cameron's charge yesterday that Labour "have ripped the heart out of the NHS" should be an easy one to see off. For the big picture is that a far better service is being offered to patients than was the case a decade ago. True, much of the extra money - raised by a national insurance rise which the Tories opposed - has gone on pay, but that is not the same as it having been wasted. Government and opposition alike are pinning their hopes on new markets in healthcare, but it is the logic of the labour market that dictates, however the system is organised, that decent wages will be needed to attract good staff. It is thanks to the decision to improve pay that there are now 80,000 more nurses in England than in 1997. Whatever the arguments about productivity, which is impossibly hard to measure in the public sector, this extra capacity has bought more and better treatment. A decade ago patients' lives were put in jeopardy by waiting times of up to 18 months; today the longest waits are just a third of that. And improvements in the management of both heart disease and cancer are borne out in increased survival rates.
Yet this argument is not proving an easy one to get across, and not just because it falls to a government mired in difficulties over everything from cash-for-honours to Iraq to make it. For the chaos facing junior doctors applying for training posts, which is the immediate cause of the weekend protests, is just the latest in a line of difficulties. Deficits requiring cutbacks in parts of the country have been aggravated by an inflexible accounting system. The new GP contract was negotiated with insufficient regard to value for money - as doctors' pay rose, their responsibility for out-of-hours care was actually reduced - and the public accounts committee is expected to conclude tomorrow that the deal has now overshot its planned costs by £300m.
In such a vast organisation, mistakes will happen. The concern in the NHS, however, is that the policies of a government determined to flex muscle and show that it is grappling with reform are aggravating the risks. David Cameron has been quick to pick up on this, highlighting the repeated redrawing of health authority boundaries and responsibilities, which has indeed been an unhelpful distraction.
Yet looking ahead, the main driver of instability is set to be the ongoing move to market-based healthcare, to which the Conservatives are every bit as committed as Labour. Hospitals have already started the shift from fixed funding to a system where they are paid for each procedure they perform, and today the prime minister is expected to set out plans to involve the likes of Boots and Tesco in running GP surgeries. As the purse strings tighten after 2008, the private sector will increasingly be substituting for, rather than adding to, established NHS provision. At that point - even if, which is not certain, the reforms successfully grind out greater efficiency - they might become unpopular. The change is more rapid than that in any other country. When he takes the reins, Gordon Brown may slow the pace. Medics would welcome that, but it might serve his own interests too.
