Our influence on NHS reform
In May we made a prediction for the great health reform debate:
“If as expected it concludes with some ‘minor concessions well spun’, no one will be pleased. A thousand authors will claim the credit. The Conservative backbenchers have already starting highlighting their own influence.”
This was unfair. The spinning has been magisterial, a master-class in repackaging that has silenced or baffled most critics, whilst leaving what were quite modest reforms largely unchanged… only masked in complexity and rhetoric where previously there was a dangerous level of clarity.
For example, Monitor, the health service regulator, previously, was to encourage competition.
Now it will only do that if patients benefit… which is no change at all… competition tends to keep providers in check to the benefit of patients… monopoly does the opposite.
It will encourage integration, collaboration, and choice… all of these things exist in competitive markets.
If any of these objectives collide, it is really very simple… they will be integrated, competitively… or the regulator will encourage parties to choose to collaborate… unless that involves competition… in which case an integrated patient benefit test will apply… or Monitor will choose from several competing tests… some requiring collaboration from other regulators… unless those are rationalised in order to encourage integration… in which case it will be passed back to the Secretary of State to choose… or collaborate with his colleagues… or pause for a genuine listening exercise… or flip a coin…
The regulatory governance of the NHS is now at least as comprehensible as that of the Liberal Democrat Federal Party.
Never let it be said we are not reshaping Britain in our own image.
June 15th, 2011 at 9:54 am
I know. It’s a mix between being farcically complicated and being delightfully vacuous.
My favourite was that caveat you mentioned, that competition will only be permitted where patients benefit. It means exactly nothing since, even on the unlikely hypothesis that patients may not benefit from competition, it wouldn’t succeed under those circumstances anyway!
So I reckon we’re probably still on for most of the reforms at less of a breakneck pace. (Contra Tim Ambler at the ASI, who thinks it’s ‘failed again’.) Which is fair enough, politically: I’d sooner get to the right place slowly than stall because we tried to go too quickly.