It’s rubbish to say the NHS won’t be National

Philip Stephens (FT) and a few others on TV are claiming that the proposed NHS reforms mean that the ‘National’ is being taken out of the NHS. This is scaremongering and just plain wrong.

What makes the NHS ‘National’? The fact that no matter where you live you can access a health service that is free at the point of delivery. Could it ever be exactly the same service no matter where you go? No, that’s the socialist dream that was never and could never be fulfilled. There will always be variation, not only because its servants are human beings but also because there will always be regional variation due to historic, demographic, geographic and voluntary-sector differences. (This does not excuse variation in health treatments where good practice is ignored by some obstructive professionals). The NHS does not have to be nationalised to be national. Any serious scrutiny of the service would show that the NHS has been a fantastically succesful public-private partnership for decades. Everything from medicine, pieces of diagnostic kit, operating theatres,beds, linen, uniform, technology and IT support to some of the dialysis, pathology, supply chain and logistics to a growing number of the operations are provided by the private sector. And lets not forget, all GPs, Opticians. Pharmacists, Dentists are private independent contractors supplying services to the NHS and many physicians and surgeons spend a lot of time in purely private practice to ‘top-up’ their NHS work. True, more accurate description may be a ‘united’ health service but this doesn’t change the reality on the ground – the service is staying national.

Meanwhile, the Health Select Committee report on commissioning is out today. A notable conclusion is that:

The White Paper proposal to abolish Primary Care Trusts and transfer commissioning responsibility to GP-led consortia was not foreshadowed in the Coalition Programme and came as a surprise to most observers.

Notable because it is only half-true. Andrew Lansley made many, many speeches on devolving real budgets to the GP Practice-based Commissioning groups that were established under Labour. The name has changed but the principle was well-known to anyone who had been listening. The bit that is true is the surprise abolition of PCTs. This came as a huge shock when the White Paper was launched on July 12th and our opinion is recorded in other blog posts – we would like PCTs to have been refined by natural attrition and streamlining as GPs took them over.

But as ever, Stephen Dorrell has led on a report that is thoughtful and provocative. His experience and wisdom should be heeded as he asks the awkward but necessary questions to ensure that the NHS thrives. The Health Bill will have 600 clauses. That gives plenty of opportunity for ammendments…