Tuesday, 17 May 2011

An unhealthy obsession: how the Coalition misses the point on the NHS

The NHS reforms are causing the Coalition their biggest headache since forming a government last May. However, unlike other headaches, this one seems less of an avoidable faux pas, and more of fundamental misunderstanding of the public mood.

Let's be clear what the NHS reforms genuinely propose: a reorientation, albeit a preliminary one, of public healthcare. While we now collectively fund and provide healthcare for each other, the Coalition want to move away from public provision, simply using pooled resources to allow us to buy our own healthcare, via GP commissioning, when we need it. Why do the Coalition want to abandon public provision? Because they want more private businesses involved in the delivery of healthcare. If they didn't want markets, there would be no point in revising the delivery of healthcare in the first place.

The question many people are asking is 'why?'. Public satisfaction with the NHS is at an all-time high, why change it so radically? In response, I think the Coalition offer two rationales.

1. Increasing individual choice. By opening up healthcare services to competition through 'any willing provider', the reforms will open up greater choice for individuals when they require treatment.

2. Maximising healthcare outcomes. By involving the private sector and promoting competition, services will improve: hospitals and healthcare providers will be more incentivised to improve the services they offer and GPs will be able to buy more quality for less money.

Both of these rationales offer competing visions of what the NHS should aim to achieve. The first vision - more individual choice - seems to me quite odd. Sure, individual choice is important in some areas of life; when we are in the supermarket, we want to be free to choose between bananas and apples. But healthcare is not like bananas and apples. We don't want a hospital that looks pretty, or a consultant who has a nice office; we just want the best service.

This is why the second vision has much stronger force for the Coalition: if we open up service provision, we will all be the better for it. While the first vision was a libertarian one, this is an issue of public welfare and how to maximise it.

However, while there are real, profound doubts about whether markets can produce better outcomes in health, this seems to be to be almost besides the point, for it ignores what I think is the third vision of the NHS and, ultimately, the vision which most of us hold dear:

3. Promoting social cohesion and solidarity.

This, I believe, is the underlying purpose why so many millions of people hold the NHS dear. We do not simply cherish the NHS because it is extremely good at maximising individual health outcomes (which it is, incidentally), we cherish it because of the values which underpin the collective, universal provision of healthcare: that we will all stand together in times of need to help each other out.

Transforming the NHS into an insurance system will rob it of this vision. It will transform the purpose of the NHS into nothing but the satisfaction of individual preferences and outcomes.

In other words, it will be just like buying bananas and apples.

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