Over a junk food lunch with NHS heavies recently I found the conversation turning – yet again – to Andrew Lansley. Is he on the level? Does he have a hidden agenda to privatise the system? That kind of thing.
I thought of that pizza summit again this week when the secretary of state popped up in the tabloids, explaining why his beloved NHS must change to provide more and better services. He recycled the story about how a hospital A&E misdiagnosed (as inner ear infection) the stroke he had while playing cricket at 35. It’s got a lot to answer for, that A&E.
My line on Lansley is that he does mean well by the NHS, its core values, staff and patients, but that his plans for reform are over-complex and likely to prove counter-productive. And he doesn’t communicate his vision well, as he demonstrated painfully at the nurses’ conference.
Some of my co-lunchers were not persuaded. Lansley and his political allies – the Conservative Medical Association and its chums at the National Association of Primary Care – do want to privatise as much of the NHS as they can get away with, they said.
What’s more, they said, David Cameron knew they were pushing the boat out as far as they dare, willing to row back only when necessary. No one should be surprised. It was pretty much all there in the Tory manifesto – and certainly in a speech which Lansley made to the NHS Confederation as long ago as 9 July 2005.
Not all of us agreed with that. Lansley wants competition, he wants an NHS market, but that’s not the same as privatisation, I recall saying.
Well, came the retort, there is lots of scope in his bill for private, profit-making providers at every level, GPs making money from services they commission too. Unless it’s cleaned up, the House of Lords will block the bill. Agreed.
I can see where the conspirators are coming from. Pre-election Tory health literature is full of warnings against “massive, structural and ultimately pointless reorganisations” (copyright D. Cameron) of the kind now in progress.
Primary care trusts would co-exist alongside GP led consortia too.
Blind or not, I did not predict the PCT upheaval. Sure enough, PCTs were still in place when I checked the July 2005 speech online. It makes a more cogent case for improving public services via choice and competition than Mr Lansley makes now that he is bogged down in detail, although he seems to think the gas and postal businesses are better models than they are.
A few key points.
“Private ownership is secondary to competition,” he said. And “if there is one thing worse than a public sector monopoly it is a private sector monopoly”. These are not sentiments Rupert Murdoch could utter.
Monitor’s future role as the competition regulator is visible in 2005. And, yes, Lansley explicitly envisaged competition by price as well as quality – because US experience suggests that quality alone will allow prices to rise too much. That’s certainly true and the Obama reforms do not bear down hard enough on costs. Yet price has now been deleted from the bill.
For a market to work consumers must be plentiful (GPs must not be captives of hospitals), well informed and have a strong voice. Unlike public transport where the customer makes a co-payment (i.e., buys a ticket) pressures for equality in health (as in education) require them to be free at the point of use, although a private sector is needed to help drive up efficiency.
All this he said in 2005: “I want the NHS to succeed.”
I believe him. It’s just that he’s doing it badly.