Never having been to the RSA before, I found myself there three times last week. This wasn’t wholly co-incidence – I had arranged to meet someone in the building, and that prompted me to go to a couple of events there.
One of these was the opportunity to hear Andrew Lansley, the Shadow Secretary of State for Health, talk about the Conservative Party’s plans for the National Health Service. (Audio download and a PDF of the speech are available.)
Unlike many of the audience, I do not have experience of working in health – I was sandwiched between two doctors. Nor am I a Tory supporter – but since they may well form the next Government, I wanted to take the opportunity to hear what Mr Lansley had to say.
What he said made sense, but perhaps understandably it lacked detail: he said what the Tories would aim for, but not how they would actually do it. It all made sense, but I couldn’t work out if it would actually happen. Lansley specifically stated that it should be cost neutral.
The Conservatives’ focus would be on the outcomes of health care, providing local autonomy and decision making at several levels.
In essence, Lansley wants to empower local services – remove central government “management-by-targets”, reduce bureaucracy, make GPs responsible for the patients’ “pathway to care” including owning the commissioning budgets for healthcare, provide “real patient choice” (I’m not too sure about this one – choice means many things to many people – choice of hospital, doctor in a hospital, a voice in the treatment offered, and so on) including opening up health provision to new providers (did someone say “privatisation” just there?) and so on.
I liked his views on devolving health decisions to local – even GP – management: devolving relevant decisions at as local a level as possible makes sense, and I completely agree with removing central government targets, which produced such perverse incentives as those seen in Stafford Hospital. But GPs should be providing primary health care: are they really the people to be managing health budgets?
Local decision making and autonomy could also mean that what is known as “the postcode lottery” – that favourite of headline writers – becomes more acute: treatments available in one area may not be available in another. Will health ministers be happy to live with that when they are questioned by the media?
For local health trusts to be really accountable, would they be elected? In which case, might there not be an increase rather than a decrease in bureaucracy, as functions were duplicated as they are decentralised?
Managing stakeholders in a change such as this would be difficult, too: keeping health workers and other service providers on board would be essential.
Whilst I think many of the ideas are good, I therefore doubt they will be put into practice: changing the system might just be too hard. (Although the alternative – let it fail and start again – is not a pleasant thought.) This is why the details are important: why actions as well as aims need to be understood.
I’ll wait and see. And maybe take out health insurance, just in case…