"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Friday, 10 February 2012

Re-politicising the NHS

Various commentators have pointed out how the NHS has re-toxified the Tory brand, and put the blame for this squarely on Andrew Lansley. In fact Lansley has done something worse - he has re-politicised the NHS.

One of the most significant achievements of New Labour was the creation of the National Institute for Health and Clinical Excellence (NICE). The fag-end of the Major government was dogged by postcode lottery scandals, and it was so long ago that people seem to forget what a huge scandal it was. At that time it seemed that a day didn't pass without something in the Press about someone complaining that they could not get treatment in their area that was available in another area. Where you lived determined the level of care you go. This was simply unfair. The postcode lottery dragged in politicians who, frankly, hadn't a clue about how the issue rose and just wanted it to go away.

NICE solved that issue, and it did so in a way that pleased everyone. First, clinicians were pleased because NICE is evidence based and all its decisions are backed up by peer-reviewed research. Second, patients were pleased because NICE is authoritative, and its decisions carry a lot of weight. This meant that a patient in one area could demand that they received a NICE approved treatment. If there were any rationing through a NICE decision the public were happy because it would apply to everyone and this satisfied the British sense of fair play. Third, politicians were happy because they were no longer held to account for complicated decisions over which they had no control. Of course, there are still some people who complain about NICE decisions, and there are always anomalies, but in general, NICE neutralised and de-politicised the postcode lottery.

Then we had Richard Taylor. This retired physician upset the political apple cart by standing for election on an NHS issue (he was against the re-configuration at his local NHS hospital at Kidderminster) and winning against the a government MP (largely because the Liberal Democrats decided, two elections in a row, not to field a candidate). The election of Taylor made politicians realise that it wasn't just national NHS policy that could affect their party's vote, but a local NHS decision, over which they had no control, could seriously threaten their own chance of re-election. The politics of this: local issues over which an MP has no control, was very similar to the postcode lottery that New Labour had neutralised.

During the New Labour times of plenty cases like Kidderminster were few, but the threat was always there. Lansley realised that if there was a Conservative government, and they enacted his plans for the NHS, there would be lots of Kidderminsters created; he feared the effect that this would have on Conservative MPs. Lansley had to create a NICE for all of the NHS. This was the reason behind the creation of the NHS Commissioning Board and it was the reason behind the abrogation of the Secretary of State duties (clause 1) and pushing these duties onto CCGs (clause 4). Both the NHSCB and the CCGs are unelected and unaccountable. Lansley calculated that in exchange for removing the so-called political micro-managing (which actually existed for patients benefits, but clinicians disliked) and removing managers and making clinical groups responsible for configurations, he thought that he could de-politicise the entire NHS.

Just as New Labour had neutralised the postcode lottery through NICE (Taylor notwithstanding) Lansley thought he could neutralise NHS reconfigurations through GP consortia (CCGs) and the NHSCB.

The problem is, rather than de-politicing the NHS Lansley has manage to re-politicise it. The overwhelming opposition of bodies like the RCGP or FPH is not due to a handful of troublemakers, the usual suspects. This opposition is from clinicians who until recently were largely apolitical. The Bill, Lansley's heavy handed implementation and Cameron's downright lies about NHS outcomes have persuaded many numbers of clinicians - doctors, nurses and other clinical staff - into active opposition. This is bad for the Conservatives because at the next election these clinicians won't forget how a Conservative-Liberal Democrat government had duped and bullied them.

Of course, it will also mean that an incoming Labour government will have to tread carefully because there is now a phalanx of clinicians ready to scrutinise their policies. I think that this will be a good thing because it will mean that Labour will have to create a much better health policy.

In a short space of time, rather than de-politicising the NHS, Lansley has managed to re-politicise it. This will have repercussions whose effects will be felt for many years.

1 comment:

  1. Your claim that the last labour government abolished the "post code lottery" is an extraordinary one. Devolution means that different NHS's exist in the four nations of the Uk. As well as that the labour government brought in practice based commissioning. As I point out in my recent blogpost "the postcode lottery" is intrinsic to the process of commissioning. NICE did have some effect in being a defacto single commissioning board for the country for some issues, but does not and can not cover all conditions. These get little funding as NICE leaves little money left over for discretionary spending by commissioners. Not covered by NICE means not funded. In England it is unwise to develop rare conditions.

    The NHS always has been political and always will be. I think that the HCSB will gain no votes for the Tories, but the prospect of Ed Milliband as prime minister and Ed balls as Chancellor will mean that they probably will win the next election despite the HCSB.

    Dr Phil