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Tuesday, December 21, 2004

Foundation Hospitals

I am rather tardy in this post, since the news is now about a week, if not further out of date. Anyway, DM Andy has an interesting post on Foundation Hospitals - one of the most contentious issues of this Parliament. My own post was originally about Foundation Hospitals, but I went off on a tangent and it has turned into some thoughts more generally on the NHS. Typically I've gotten into mixing analogies half-way through. I apologise in advance for the length.

Anyway, as I understand the whole business Foundation Trusts are meant to be freer from governmental controls in matters financial, the theory being they will be more effective at managing their own affairs. In principle at least I've been in favour of the idea - the idea that generally some bureaucrat in Whitehall knows better than people in, say, Somerset how to deal with the area's health-related problems doesn't hold up for me. In practice I'm warier, at least partly because I don't believe there is the goodwill from the Treasury to allow them to work (admittedly I'm biased against Gordon Brown, but I do think he is the worst offender in that regard). Word of Fondation Trusts complaining about government red-tape do not reassure me in that regard (Andy links to a couple of Guardian pieces).

However, I think in some respects the substance of Andy's post goes to a deeper problem that I think is at the heart of the NHS - that of money, or more accurately that of there not being enough money. Now, I've only been working in the NHS for a little over a year, but I know of a few examples where Peter has been robbed to pay Paul. It is a problem that is largely ignored because the moralities of the business are, quite literally, mortal. The fact is that the British people have been consistently lied to, and led to expect a service for relatively.

You see, the health service is "free" - sometimes politicians qualify this by saying "free at the point of need". Prescription charges demonstrate the lie of the qualification of most people's experiences of going to the doctor, and the tax-bill should explode the myth of the first. Yet for all its unfree nature the NHS is essentially poor - it is expected to do everything, but the public (and politicians) doesn't give it enough dough to make the loaf.

There are two standard responses to this, either increase the amount of dough or try to make it stretch further. Gordon Brown has been piling more dough into the system for the past few years, but the fact is the NHS is inefficient. Throwing more money at the problem is just like throwing water aimlessly at a house-fire - sure enough will get the job done, but hardly efficiently, and if you don't have enough water...

So then comes along the second response - try to make the dough you have stretch further, to make it more efficient. Foundation Hospitals are one of doing this, PFIs (Private Finance Initiatives) are another. There is a new-fangled IT system they hope to bring in to do the same - though with this government's abysmal record on computer systems I'm not keeping my hopes up.

I personally think, to go back to the burning building analogy, that sometimes you have to wonder whether it is wiser to let the building burn down and then rebuild something better than went before. I simply don't believe the NHS is sustainable in the medium to long term (by which I mean 20-100 years). Far better I think that we need to try and address this now, rather than cling to decaying corpse like the fallen kings of Numenor. Or, to use a medically related analogy, if you are lucky enough to have an early diagnosis of a well-defined local tumour it is simply madness to wait for it to metastasise all over the place.

But I admit, on the issue of the NHS I'm long on rhetoric and personal grievance, but short of answers. In general I think I support some sort of national insurance system, which people can mostly opt-out of. In wilder moods I will happily advocate tearing the whole system down completely (along with a reverse "decimation" Whitehall - which means the person who draws the short straw would keep his job). We all have flights of fancy, but even my slightly more realistic views are way out of the currently possible. But, as a left-leaning friend of mine pointed out to me a few months ago that in 1970 nobody suspected that the new Education Secretary would have such a profound impact on British society, or that she would so dramatically shift the political boundaries. Her name, of course, was Margaret Thatcher (to cover both sides of the aisle I wonder how many people in 1900, when the Labour Party won 2 seats in Parliament, that they would be the government just 23 years later).

In the so-called Orange Book a group of important Lib Dems published there was apparnetly one essay seriously arguing the case of such radical reforms. Of course the suggestion was quickly batted away - Charles Kennedy was not about to commit electoral suicide after all - but at least perhaps a true debate about the health service might be, just beginning, to take place.

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