Health Reform

Deputy PM Mr Nick Clegg and the Liberal Democrats have been claiming victory in the struggle to make NHS reform more progressive. The party certainly seems to have won much of what it wanted (BBC, 12 June 2011).

In order for Liberal Democrats to get what they wanted, their Tory coalition partners are being forced to back down from long-time promises to introduce more competition to the NHS (BBC, 14 June 2011). The focus on competition has had to be relaxed as the NHS listening exercise says slow down, increase accountability to elected officials, increase the involvement of professional opinions and to only use competition where it can clearly 'secure greater choice and better value for patients' (DoH, 2011).

Furthermore, the Tory part of the coalition has been less than impressed with Liberal Democrat celebrations (Watt, 2011). On the opposition benches the Liberal fight for a more progressive policy has met a lukewarm response at best.

There are concerns and suggestions that the listening exercise has led to proposals that PM Mr Cameron ought to show far more favour to 'protectionism' in the health market than either of the previous Labour Premiers did (BBC, 16 June 2011{1}). A particular critic is former Labour health secretary Mr Alan Milburn. Mr Milburn has been vocal in his criticism, but not just of reform plans.

While Mr Milburn levelled criticism at the government for its attempt at the 'biggest nationalisation' in NHS history, he also pursued Mr E Miliband's Labour Party for its willingness to back away from what he called 'radical territory'. In this case the 'radical' is allowing the market access to the British healthcare system to end what Mr Milburn calls 'public sector producer-interest protectionism'.

All of this debate about public funded health is occurring  with a background of public sector reforms that are sparking talks of mass union action (BBC, 16 June 2011{2}). Shadow Chancellor Mr Ed Balls has responded on behalf of Labour's current frontbench team, urging all sides to towards calm in matters ahead (Stratton, 2011). Mr Balls warns against falling into a 'strike trap' which will only benefit the Tory Chancellor against whose measures strikes would be aimed.

The Shadow Chancellor's calls for the sides to get back around the table to find a smarter solution will be good news for those in the coalition who wish for less confrontation, such as Chief Secretary to the Treasury, Liberal Democrat Mr Danny Alexander who said he believed there was a 'huge amount of room for dialogue'.

So this is the deadlock that faces the future of the NHS. With it, a few questions come to mind:

+ Firstly, to what purpose where National Insurance & the NHS set up initially?

+ Secondly, how progressive are these reforms proposed by the listening exercise?

+ Thirdly, how do these two match up and what can still be done?

Well the ball was set rolling by the National Insurance Act of 1911, brought in on the back of the People's Budget of 1909 which was described by its champion and Liberal Chancellor David Lloyd George as:

'a war Budget. It is for raising money to wage implacable warfare against poverty and squalidness. I cannot help hoping and believing that before this generation has passed away, we shall have advanced a great step towards that good time, when poverty, and the wretchedness and human degradation which always follows in its camp, will be as remote to the people of this country as the wolves which once infested its forests'
       - David Lloyd George, Announcing the People's Budget, 29 April 1909

This purpose has been refined & reformed over time; Atlee & Bevan passed the NHS Act in 1946, expanding the means at Britain's disposal for tackling Beveridge's Giants; that is Want, Disease, Ignorance, Squalor & Idleness (Taylor, 2009).

Amongst the new proposals is a recommendation that the Secretary of State for Health 'should remain accountable for the NHS' which, combined with the call to limit competition to where it can improve choice & quality of services; is certainly a progressive suggestion. To assure a democratic say in the running and consumer's say in the service, as a means to promote the best quality and affordable access is surely within the scope of those original aims.  There are however, some who are not so sure that these proposals are the end of the story, with Dr Meldrum of the BMA suggesting that they 'don't think the privatisation genie is back in the bottle' (Triggle, 2011).

The initial implementation of National Insurance took much work, compromise (dropping Land Tax proposals) & even constitutional reform (Parliament Act 1911) before it came into being. There is no reason then not to think of these reforms as anything other than part of an ongoing process. The reforms offer a way of striking the balance between the cost-effectiveness the market can bring, something that is suggested to be key in assuring the NHS can be funded adequately in the future; and the need to insure that the UK maintains its health service that is nothing short of a wonder of the world. A system where everyone has access to free services at the point-of-use, which prevents one of the 'poverty traps' present in other parts of the world.

There is of course a fourth and final question. How far will the Tories be willing to meet the proposed adjustments to their healthcare policies?

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References:
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+ BBC's 'Nick Clegg to claim NHS changes victory for Lib Dems'; 12 June 2011;

 Nick Clegg's 'How we’re protecting our NHS'; Listening Exercise Statement from Guy's Hospital; 14 Jun 2011;

+ BBC's 'Cameron backs wholesale changes to NHS plans'; 14 June 2011;

+ Department of Health's 'NHS Future Forum publishes recommendations to Government'; 13 June 2011;

 NHS Future Forum recommendations to Government; Downloads;

+ Nicholas Watt's 'Nick Clegg under fire over health reform 'victory''; 12 June 2011;

+ BBC's 'Milburn calls amended NHS plans 'a car crash''; 16 June 2011{1};

+ BBC's 'Coalition 'losing its way' on public sector reforms'; 16 June 2011{2};1

+ Allegra Stratton's 'Ed Balls warns unions of George Osborne's 'strike trap''; 19 June 2011;

+ Nick Triggle's 'Analysis: Why the NHS wants to move on'; 14 June 2011;

+ Matthew Taylor's 'Global Giants'; in Duncan Brack, Richard S. Grayson & David Howarth's 'Reinventing the State: Social Liberalism for the 21st Century;  Politicos, 2009.