There is no doubt that the government's proposed NHS reforms have proven to be controversial. Originally backed by Lib Dems, Andrew Lansley has now lost their backing as the party descends into panic mode after the poor local election results. Without the support of the Lib Dems the reforms stand little chance of getting on the statute book.
It seems the main sticking point for the Lib Dems is the extent to which the market will play a role in the provisioning of a free-at-the-point-of-use service.
But, what is this evil market that is threatening our fantastically efficient and effective NHS, in the minds of the left anyway? If you read the Guardian or watch the BBC you'll be under the impression it is some kind of malign mechanism that is designed to sap whatever is good out of anything that comes into contact with it. A diabolical agent of the right wing, whose only purpose is to destroy the NHS and replace it with a US style health care system, where only the rich can afford decent treatment and the poor will be left to die in agony on the streets (because they'd have sold their homes to pay for what inadequate treatment that could pay for).
It suites those on the left, the statist planners and advocates of entrenched public sector interest, to characterise the market as a thing, a device, usually portrayed as an ideological paragon at the heart of the plans of frothing mouth right wingers hell bent on suppressing the poor and enriching their banker mates in the city. But, if you haven't already dismissed this as ridiculous (genuinely) idealogical nonsense, think on a bit more.
What is "the market"? It is nothing more than the choices made by you, me, our neighbours, their friends and family, in fact everyone. It's not an extraneous body with an agenda of it's own. Why shouldn't our needs as patients be put at the heart of our health service?
In Britain we have come to expect a free-at-the-point-of-use healthcare system. There are some powerful moral arguments for it and it appeals to our sense of fairness, that everyone, regardless of ability to pay, should receive the best healthcare available. We call the system the National Health Service and we are all very attached to the concept. And quite right too.
Free at the point of use it maybe, but cost free it certainly isn't. The cost to all us tax payers runs to over £100 billion a year. It has the income of a small nation but with the burden of expectations of a very large, complex and demanding one. As multiple reports over the years prove (including this one), the NHS is neither efficient or effective in delivering the standard of care we expect. As someone who has had a love one almost die of malnutrition on an NHS ward, I know for a fact that reform is needed.
The model we use currently is predominantly based on services being delivered by state owned entities and staff. New Labour's early reforming zeal attempted to introduce a more modern and competitive environment but met the same seemingly immovable forces of self interest in the form of public sector unions and others, such as the doctors' union, the BMA, who mobilised to scare the general public and the Prime Minister of the day into believing change was too risky. Old Labour fifth columnists like Gordon Brown and Ed Miliband made sure these voices were heard and moved to scupper all subsequent attempts at reform that threatened their friends and party funders and (as they saw it) loyal Labour voters in the public sector. Sadly, history may be repeating, with Cameron replacing Blair and Clegg replacing Brown. Cameron may not be worried about upsetting Labour voters in the public sector but he is worried about re-contaminating the Tory brand with the poisonous idea, no matter how untrue, that he wants to privatise the NHS.
So, we're spending enormous sums on an organisation built on the 1940's concept that centralised state planning and provision is the only way to provide a national health service free at the point of use. This approach has failed to deliver consistently excellent service as expected. There's been much tinkering at the edges to attempt to improve things but nothing that has been in any way adequate. And now the money's running out. David Cameron is committed to maintaining real terms funding and is avoiding real NHS budget cuts. However, after a decade of fiscal incontinence that has seen the NHS's budget more than double, the organisation has lumbered from poor productivity to worse. Some, politically motivated performance targets have been met (especially around elective appointments) at the expense of professional medical judgement in many cases and overall quality of care has dropped.
What's needed is choice. For example, GPs should be able to assess the performance of local care providers and send patients to the most appropriate one dependent on their needs. If that happens to be a private outfit rather than a public one, so be it. As far as the patient is concerned, it is free. The only difference would be quality. Where appropriate the patient should be provided with adequate information to be able to make informed decisions of their own about where and how they are treated.
I think the proposals have been rushed out and not communicated to key stakeholders in healthcare or to he general public very well. Taking time to pause and refocus is sensible. But, if the reforms are watered down or delayed until the next parliament we will merely end up with an organisation that has grown to rely on massive year on year budget increases to achieve bare minimum standards, if even that at times, facing the prospect of budget increases at barely inflation levels only. It won't know how to adapt. Services will be cut instead of unnecessary bureaucracy, productivity will carry on falling, outcomes will continue to lag behind international standards, cost efficient prevention will still play second fiddle to expensive cure etc etc.
Those that oppose the market playing a larger roll in the provision of healthcare are opposing the NHS becoming more responsive to our actual needs. They prefer to promote their ideological belief that only the state can provide adequate healthcare, despite all the evidence to the contrary.
All that patients care about is that their treatment is of the highest possible quality and free. Who provides it is irrelevant.