Posted on 03/16/2006 3:43:35 AM PST by Straight Vermonter
Has there ever been a more bizarre notion of political responsibility? The NHS is currently engulfed by a deep financial crisis as it careers towards a deficit of between £600 million and a staggering £1 billion.
Operations are being cancelled. Hospitals and primary care trusts have frozen staff vacancies. Managers are even threatening to withhold tax and national insurance contributions because they don’t have enough cash to pay them. The service is descending into chaos.
As result, the NHS Chief Executive Sir Nigel Crisp has walked the plank. The Government’s insistence that he took early retirement entirely of his own volition is frankly incredible. In fact, he very decently acknowledged responsibility for the service’s problems, as well as for its successes.
So a career beached in ignominy? Hardly. For Sir Nigel has been given a life peerage -- one of only a handful in the Prime Minister’s gift for public servants who have made a particularly distinguished contribution. For this failure to stop the NHS sliding into financial chaos, which has caused him to depart so precipitately from his post, Sir Nigel has therefore been rewarded with a Whitehall plum.
Confused? In the surrealist and unending disaster epic that is the NHS, very little makes any sense. Unprecedented amounts of money have been hurled at the service by the Chancellor -- and yet we learn that, some four years on, the NHS appears to be going bust. So how can this have happened?
The immediate reason is that almost all this largesse has been swallowed up by salaries, pensions, drugs, IT systems and other commitments which cost far more than had been expected. As result, virtually no money was left for improving the actual delivery of services to patients, without what are euphemistically called ‘efficiency savings’ – or cuts to you and me.
These were so vague as to be next to useless. So almost all the Chancellor’s extra billions disappeared into the mechanics of the system. Meeting the demands by ministers for more, better and faster treatment sent the service shooting into the red.
In a more honourable age, the Health Secretary presiding over such a shambles would have fallen on her scalpel. But here, surely, is the explanation for the ennoblement of Sir Nigel. His peerage was a sop to sweeten the bitter pill of being made the fall-guy for a politician who was determined not to take the rap.
Sir Nigel should not have been sacked, because the job he was given was simply impossible. He was being expected to turn round a service which was being driven off the rails by the incoherence, arrogance and incompetence of Government policy.
What has happened has tested to destruction the old excuse that the problems of the NHS were due to lack of money. We now spend more on health care than the European average, but it has vanished into a managerial black hole. An unprecedented level of spending has simply produced an unprecedented level of crisis.
This was entirely predictable; indeed, it was in fact predicted by many commentators. The government was warned that this would happen by Nick Bosanquet, the distinguished professor of health policy; it was warned by the influential Reform think tank; it was warned by the OECD, which said that such an enormous amount of money simply could not be processed efficiently in such a short amount of time.
The Government ignored all of them. Instead, it pressed forward with one ill thought-through and incoherent policy innovation after another. The reason Sir Nigel was unable to constrain NHS spending was that its managers were being driven to meet unrealistic ministerial targets -- in particular, the policy of reducing treatment waiting times.
It was this policy which meant that more patients had to be processed faster, even though there wasn’t the money to do it. It was this policy which grossly distorted clinical priorities. It was this policy which shunted patients onto ‘ghost’ waiting lists -- which didn’t officially exist -- to artificially massage the figures downwards.
And all this to provide the illusion of improvement, so that ministers could make an empty boast that would hoodwink the voters.
Now the Health Secretary Patricia Hewitt claims that only ‘a very small minority'’ of hospitals and NHS bodies have serious financial problems. One shudders to imagine what she thinks a large problem would look like. It should not have been Sir Nigel who resigned but the Health Secretary herself.
The notion of ministerial accountability, however, seems to have gone out of the window altogether. Indeed one of the reasons for creating an NHS executive was to enable ministers to do precisely what Ms Hewitt has done -- to wash their hands of the mess that their own policies create. They keep the service under control so tight that it cripples it -- and yet they refuse to accept responsibility when things go wrong.
But although the Government won’t admit this, Ms Hewitt’s own job is also impossible. This is because the NHS is simply unmanageable. Since the mid-seventies, government after government has tried to reform it. Yet every one has made things worse so that the service merely lurches from crisis to crisis.
The reason is that it is simply too big. According to some measures, it is the third largest employer in the world. In England and Wales it employs around 1.3 million people, or around one in every 40 people. It is just not possible to manage such a monster from an office in Whitehall.
The bitter irony is that the very premise of the NHS is proving its undoing. Taxpayers’ money is spent on the nation’s health care by ministers -- who thus inevitably tell the service what to do.
And what that means is that no government can solve the NHS crisis, because government itself is the problem. Instead of a health service funded by the Treasury, therefore, the solution has to be a different model of funding altogether.
The fairest and most efficient alternative is a form of social insurance as practised in Europe, where waiting lists are virtually unknown. Patients purchase healthcare from providers of their choice, with the state guaranteeing levels of provision covering the poorest in society.
Our NHS is a shibboleth because people assume it is the only system that is fair. But this is simply untrue, as anyone who has seen the often shameful way that it treats those who are both poor and elderly can testify.
The present system is already a lottery which will become dramatically more unfair as the population ages and new treatments become available. Cancer care alone is forecast to cost an extra £15 billion by 2011. The consequent rationing will become unendurable and unsustainable.
Sir Nigel has gone, but there is no sign that Ms Hewitt has the faintest idea how to address this crisis. She’s still talking about bringing down waiting times to 18 weeks. But as Professor Bosanquet says, this policy – which has not even been properly thought through – should be abandoned before it causes yet more distortions, chaos and patient distress.
In the longer term, radical thinking is required. The NHS is the Titanic of health care. Rearranging the deck-chairs yet again will not save it from sinking.
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bump
About the only things I can agree with you on is need for tort reform and that America has the best universities. I am a Capitalist not a Socialist.
Given that healthcare is a limited good required by all, that means it is necessarily rationed. (Feel free to dispute this claim, but please use economic arguments)
Other examples are water, fishing rights, pollution rights and the electro-magnetic spectrum.
All of these things are rationed in every industrialized country.
The only industrialized country that doesn't have universal healthcare is the United States. And that (among other reasons) is why Toyota is crushing the American car companies.
Would like like to pay my Medicare Employee matching funds for each employee each month? We have free medical care for all who need it. It is the illegals and freeloaders along with greedy malpractice attorneys that are bleeding our healthcare to the brink.
I wouldn't live in Europe (up to 12% unemployment) and have to wait a year for a mamogram or a prostate check when all I have to do is make an appointment a recieve this service in less than a week in the states for under $500.00.
"If you think healthcare is expensive now, wait till it's free." P.J. O'Rourk
Be interesting to know what the repsective tort laws are in coutries where nationalized healthcare exists. If I had to pick one single thing to focus on for turning our free market healthcare system around, I think it would be DRASTICALLY limit liability for the care provider. Something simple like a consent form that says: "Do you want to live?" If you check yes, the liability is immediately limited to the actual costs of the procedure and/or care.
I have an acquaintance that is a surgeon. He pays ~$300K/year in malpractice insurance. If he ever has to make a claim, he is pretty much washed up in the business as he would no longer be able to afford insurance so he could work.
I will not willingly give up another freedom and raise my taxes for an amorphous promise of "free health-care". In this country I suspect that one unintended consequence will be a doctor shortage. Why work incredibly hard to become an MD only to have the government (as planned in Hillary-Care) set your salary?
1. If you want to work, you can find a job. The 12% are people who don't want to work
2. Only the British have to wait. Every other country has fantastic and immediate care. The British even send some of their patients to Germany.
I'm glad you are happy with high taxation and a socialist government. I recently worked the Nikon BV PMA show in Orlando with representative from Germany, France, U.K., Russia, The Netherlands and few others. They felt a little differently than you albeit they loved their countries.
You are only parroting the myth of the HMOs and Pharmaceuticals who are the only winners from the system
Did you read the part about how Germany has more doctors per capita than any other country? They still do pretty well and some only take private patients and do even better if they are good.
Secondly, you already pay huge sum for healthcare. If 16% of US GDP is going to healthcare, where do you think that is coming from? Reduce it to 12% and there is a huge benefit for the whole country including you.
Keep in mind the US only spends 4% of GDP on the military. Are these numbers too difficult for you to understand?
I didn't say I was happy with high taxation. There are huge problems in Germany and there are enormous wastes of money are millions of lazy slobs. But we are talking about healthcare and you are parroting the propaganda of the HMOs and Pharmaceutical companies that are the only winners from the absurd American system.
Bring down the cost of healthcare from 16% of GDP to 12% and cover everyone and then you have the best system in the world. Until then, the big country equivalents in Germany and Japan are far superior based on pure cost/benefit analysis.
Based on your patriotism warped by propaganda however maybe there is nothing that can be done to convince you that a system that spends more for less is somehow better than the reverse.
Really? Then why is Medicaid sucking up over 90% of my county's budget?
The Blair government has stripped the former British colonies of doctors and nurses to try to improve the provider to patient ratios, but IMHO the basic problem is that the whole mess is too expensive to sustain, especially in an aging society.
Thank you for your insight. Our problem here in the states is whenever our government gets hold of anything with our tax dollars it goes to hell in a hand basket. 12% goes to 15% then 25% and so on. Nothing improves. More government regulation and more taxation is the only result. Hell, look at the FEMA disaster. 250 Billion to rebuild New Orleans? That's 1.2 million per resident. I don't think so. What would they do with health care? Frightening thought. A disaster waiting to happen.
Doof da boofen bumb.
But the Brit's have machines that go 'ping'!
Price is the most efficient for rationing. Rarely, if ever, is it mentioned that health insurance is probably the greatest driver of health care costs, i.e. coverage by insurance increases demand.
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