So what are these proposals that no-one dare let Liberal Democrats see at Conference?
There is an increasing body of reputable opinion and evidence that market competition is an expensive irrelevance in healthcare. It is interesting to note that every government since Margaret Thatcher has pursued the same policy: that of exposing the NHS to more and more market competition. The assumption has been that the only way to raise standards and reduce prices in the NHS is the market. Recently a string of professors have spoken out. Calum Paton and Alan Maynard on the costs of running a market, Clare Bambra on widening inequalities and Chris Ham on the way competition is a barrier to the provision of integrated care. Judith Jolly, until recently the co-chair of the Liberal Democrat Parliamentary Health Committee said that the action taken by the Competition Commission over the proposed merger of Bournemouth and Poole Hospital Trusts was scandalous “We need to sort out the competition thing.” Chris Ham says that we need legislation to unscramble at least some of the Lansley Bill. David Nicholson, chief executive of the NHS, has said that competition is a barrier to delivering quality.
Several witnesses to the Public Services Policy Working Group have pointed out the advantages of funding healthcare by means of a capitation budget, but acknowledged that this was very difficult when operating in a market of many providers.
My proposals are simple but radical. The full document with supporting evidence is available.
- Set up Local Health Boards covering populations of around 1 million.
- Abolish the market (internal and external) in healthcare.
- Give Local Health Boards a budget based on capitation and direct management of hospitals, community services and GP contracts in their area.
- Pool nationally the PFI debts of hospitals, to facilitate the re-negotiation of those debts.
- Give patients the choice, through their GP to be referred to any NHS hospital in the country.
These proposals would render redundant a large number of national quangos and return at least some measure of local democratic control over the delivery of health services. The costs of running a market are already large and are set to rise very greatly. These proposals would therefore save large sums of money, and a very considerable amount of clinician and management time. There are more details in the full document and there is more work to be done. We need to bring together the fragmented Public Health roles and work on integrating health and social care but these proposals would, I believe, go a long way to alleviating many of the cost pressures on the NHS and removing the key barriers to integration and improving quality.