Politics On Toast’s very own A.P. Schrader has been appointed health secretary by Her Majesty’s Government (yes, really). In his first act he abolishes the Department of Health. Next he razes and rebuilds the National Health Service – one that will compete for our business.
What would I do if David Cameron appointed me Health Secretary tomorrow? I dare say Andrew Lansley still asks himself that question every night before he goes to bed. Or does he? Jacqueline Davis of The Guardian would have us believe that the Coalition’s apparently Lib Dem-led U-turn “was a fake” and that the Lansley reforms “remain on track”. We can only hope. Even if they are, however, I have serious doubts as to whether the Lansley proposals go anything like far enough, even in their un-watered down condition.
Our National Health Service is facing a funding crisis. We are all living longer and the financial burden on the service is overwhelming. There is a clear case for reforms that allow greater competition among providers and more choice for users. Yet all the Left do is continue to denounce competition, even though the evidence from around the world could not be clearer that competition in the provision of medical services drives up standards. It was Tony Blair who introduced treatment centres provided by the private sector for low-level procedures (which have duly outperformed their in-house NHS counterparts and delivered dramatically reduced waiting times). The notion that we can just carry on blithely ploughing money into an unreformed health service is divorced from reality. That is why the Tory Party’s decision to ring-fence the NHS budget was always absolute folly. We are dealing with the biggest deficit in living memory and other departments face massive cuts. In that context, excluding the second-biggest spending department – with a bloated £100bn budget and employing a quarter of all public sector workers – was simply absurd.
The NHS does many wonderful things but let us take off the rose-tinted glasses for a moment. A great deal of the care it presently provides is also just plain awful. One only has to look at the recent scandal of mentally ill patients being abused. No change, then, ought not to be an option.
So, the Schrader household gets the call from Downing Street and I turn up at Richmond House for my first day on the job. What do I do? Well, the first and most important thing I would do is resign. Having accepted that I simply do not have a clue how to run a health service (as, indeed, did none of my predecessors either), I would use my first and only piece of DH letterhead to write the PM a memorandum outlining my recommendations as follows:
1. Abolish the Department of Health.
2. Abolish the NHS in its current form.
I strongly believe that the DoH should be wound up and the office of Secretary of State for Health downgraded to a Minister of State for Public Health (or even a parliamentary-undersecretary working out of another department). Obviously a responsible government will wish to task a Minister of the Crown to monitor and exercise a proper scrutiny of public health issues but, otherwise, cease trying to micromanage healthcare delivery from Whitehall.
The second part of my radical plans would be to incorporate the NHS under a Royal Charter (not unlike the Bank of England or the BBC). As a corporation, free from the dead hand of the State, its services could be overseen by a Board of Governors (appointed independently), who would regulated the NHS and represent the interests of the British public. NHS Governors would be independent of the Executive but would nevertheless be accountable to Parliament and to taxpayers.
While the NHS would remain a ‘state-owned’ healthcare provider, this new incorporated NHS would be insulated from political interference by a statutory independent governing body. The Governors would approve NHS policy and strategies, set objectives, oversee any complaints and produce an annual report documenting NHS performance in key areas. The Board would have a non-executive chairman and appoint a Director-General to head up the day-to-day management of the NHS. The Director-General would chair an Executive Board responsible for operational management and delivery of services within a framework set by the Governors. I would suggest someone like Lord Darzi of Denham would make an excellent first Director-General of the NHS.
A Royal Commission would probably need to be established to examine the details and, in particular, questions of how we fund a heath service for the future. My own inclination would be to entirely reconfigure the NHS as a funder of last resort alongside a modified national insurance scheme.
Fundamentally, though, I believe in competition. I still want to see the creation of a proper healthcare market in this country. When I stub my toe or accidentally fix my hand to something with a nail gun, I want to see hospitals openly competing with each other for my business. If there’s a bad hospital down my road, I want it shut down or subsumed by a successful one. I want hospitals to have access to a dynamic and enthusiastic labour market. I want to see an end to counter-productive nationalised pay agreements and commercial free speech exercised, with hospitals allowed to proactively advertise their services. Finally, and crucially for any meaningful progress to be made, we need to see the nursing trade unions and so-called ‘representative bodies’ (who only represent the outdated ‘producer interest’) broken, Thatcher-style. These bodies have failed doctors, nurses and patients by frustrating all attempts at substantive reform. They cling to their outmoded agendas and Left-wing ideological baggage the way a shipwrecked sailor clings to the floating debris of a sunken ship. These Left-wing trade unionists are only interested in demanding more taxpayer funds to pour into a financial black hole.
Maybe I am a radical (not to mention short-lived) Health Secretary but I believe that only when healthcare is subjected to the wrath of consumers, rather than the impotent whimpering of a frustrated public faced with the hulking edifice of a public sector monopoly, will it truly become a responsive and sustainable service with the resources it needs to deliver the high quality world class healthcare service the people of this country need and deserve.