Thursday 28 April 2011
That's what its all about
As another set of figures on the economy's performance over the last quarter comes out, just one week ahead of the referendum, it is becoming increasingly clear that the fortunes of Nick Clegg and the Liberal Democrats will be largely dependent on how the economy progresses. With the No campaign gaining ground as we approach the referendum, Liberal Democrats' hopes for reforming the electoral system, not only to solidify the ground underneath their supporters' feet, but also for changing the system away from the grip of the two major parties vested in the FPTP system look set to fail. If those hopes die, his and his party's political future will be decided entirely by the legacy they leave behind. That's the choice they made after the Hung Parliament and the decision they sealed in the coalition agreement. If growth can be restored, I believe much of their original support will too.
Monday 18 April 2011
Biting the Bullet on the NHS: Thatcher returns to the healthcare debate
In recent weeks, the government's plans for reforming the NHS have come under increasing pressure from Labour, the BMA and most recently, the RCN passed a vote of no confidence in Andrew Lansley's management of the bill by 96%. This has forced the government to take up its 'listening exercise' while the bill sits in the middle of the law making process in Parliament. So are the reforms (which is the largest in the NHS's history since its creation) an application of free-market principles as its critics argue or is it another 'difficult but necessary' consequence of deficit reduction?
The government's 'listening exercise' came under heavy fire, even as it took its first tentative steps with a joint press conference of the PM, deputy PM and the Health Secretary. It was accussed of being just another PR exercise, typical of a Prime Minister who thinks his delivery rather than substance is failing (as labour supporters claim). Andy Burnham, the former health secretary claimed just that, and Ed Miliband looked to step up the pressure by calling for the reforms to be completely 'junked'. Ignoring this cheap choice of word, it has become common place these todays to expect no less from the leader of the opposition who continues to fail to provide any alternative, let alone constructive criticism. Similarly, as Labour's election coordinator, Andy Burham's comments seem symmetrically, strategically placed, not to save the policy from its flaws, but to contribute to its sabotage. Having burnt off this fog of partisan presentation which seems to blur all mediums of policy communication and reporting, I can turn to the more serious task of the debate over substance....
As in all other areas of policy, the government's plans were founded in the argument over the national deficit and government plans to emilinate the structural deficit of the state by 2015. Quite simply, the NHS is operating in the economic circumstances of the previous decade where it could afford to suffer from the inefficiencies which plague it thanks to Labour commmitments of large-scale investment and funding. Today, the NHS's ineffeciences are neither sustainable nor economically acceptable. To combat this the governments plans propose to move the responsibility to commission services and therefore control the NHS budget from Primary Care Trusts (PCT's) to GP Consortia. Firstly, this will make savings by removing the PCTs as a management level entirely and moving their role as commissioners to GP Consortia, the very practicioners who are meant to be most in touch with public concerns over care. Secondly, the government is trying to cut out inefficiencies in the large acute trusts (hospitals) by opening up the commissioning of services to all service providers including private and volunteer companies. This means acute trusts can become centres which specialise in emergency or unplanned care and no longer provide the more simple planned care routes for which there is a far greater demand and which it provides so inefficiently, therefore saving the NHS money. This solutions appears both logical and credible.
However, critics including Mr Miliband argue this process is against the values embedded in the NHS since its creation. On the 4th April while addressing the RSA, Ed Miliband claimed of the Health and Social Care Bill, 'on grounds that it doesn’t meet the challenges of the future, that it weakens rather than strengthens accountability and that it threatens the ethos of the health service, these changes are simply wrong.' His first contention is really a technical point in which he is simply reflecting that David Cameron's plans are more economically driven than in the interests of reforming healthcare to deal with future challenges, a key platform on which he is basing his reforms. This is true because, as lobbyists for the acute trusts have argued, private providers will 'cherry pick' services which have relatively cheap costs, receive higher demand and has larger profit margins. Therefore they are unlikely to provide the more major and serious services which attend to the changing needs of an ageing population. His second point about accountability plays on the fact that there will be a conflict of interest in the new structuring system where GPs are both commissioners and service providers. Thus, they are likely to have vested interests in where the money goes. Finally, he makes a symbolic point that the apparent 'privatisation' of the NHS is against the 'ethos' and values upon which the NHS has been guarded since its creation. Rather than seeking out an internal solution, he remarks that David Cameron has simply turned to the free market for a solution which will jeopardise the position and symbolic significance of the NHS in the public's eyes, in the nations identity and for every government to come.
Although the claim of privatisation is rather weakened by the fact that the costs of a service will continue not be determined by the provider but by the commissioner (which retains the principle of selection by quality rather than cost, as acute trust representatives maintain), a larger proportion of healthcare provided in this country will come from private companies. More ideologically important to Mr Miliband and representatives of acute trusts (all those who work in hospitals), private companies will reap profits from the taxpayer whereas, under previous NHS providers, all profits would have been reinvested within the acute trusts, a sour point for all who respect and value the principles of the NHS. Ultimately, despite all these criticisms, the point remains that we can no longer afford an NHS ridden with such inefficiences. Very much like Mrs Thatcher before him, Mr Cameron has decided this failing industry cannot be subsidised just because of the symbolic importance it holds in the minds of the nation, the free market must reign. And for all his just criticism, Mr Miliband has been unable to provide an alternative idea let alone a viable solution. Sticking to his ideological guns he will continue to hold the position that these 'cuts' are threatening frontline services and most importantly: jobs. So, politically, the debate returns to the age old partisan question: is unemployment a cost worth paying? Even if this 'listening exercise' is just a PR stunt, we know who holds power and we know who will say yes.
The government's 'listening exercise' came under heavy fire, even as it took its first tentative steps with a joint press conference of the PM, deputy PM and the Health Secretary. It was accussed of being just another PR exercise, typical of a Prime Minister who thinks his delivery rather than substance is failing (as labour supporters claim). Andy Burnham, the former health secretary claimed just that, and Ed Miliband looked to step up the pressure by calling for the reforms to be completely 'junked'. Ignoring this cheap choice of word, it has become common place these todays to expect no less from the leader of the opposition who continues to fail to provide any alternative, let alone constructive criticism. Similarly, as Labour's election coordinator, Andy Burham's comments seem symmetrically, strategically placed, not to save the policy from its flaws, but to contribute to its sabotage. Having burnt off this fog of partisan presentation which seems to blur all mediums of policy communication and reporting, I can turn to the more serious task of the debate over substance....
As in all other areas of policy, the government's plans were founded in the argument over the national deficit and government plans to emilinate the structural deficit of the state by 2015. Quite simply, the NHS is operating in the economic circumstances of the previous decade where it could afford to suffer from the inefficiencies which plague it thanks to Labour commmitments of large-scale investment and funding. Today, the NHS's ineffeciences are neither sustainable nor economically acceptable. To combat this the governments plans propose to move the responsibility to commission services and therefore control the NHS budget from Primary Care Trusts (PCT's) to GP Consortia. Firstly, this will make savings by removing the PCTs as a management level entirely and moving their role as commissioners to GP Consortia, the very practicioners who are meant to be most in touch with public concerns over care. Secondly, the government is trying to cut out inefficiencies in the large acute trusts (hospitals) by opening up the commissioning of services to all service providers including private and volunteer companies. This means acute trusts can become centres which specialise in emergency or unplanned care and no longer provide the more simple planned care routes for which there is a far greater demand and which it provides so inefficiently, therefore saving the NHS money. This solutions appears both logical and credible.
However, critics including Mr Miliband argue this process is against the values embedded in the NHS since its creation. On the 4th April while addressing the RSA, Ed Miliband claimed of the Health and Social Care Bill, 'on grounds that it doesn’t meet the challenges of the future, that it weakens rather than strengthens accountability and that it threatens the ethos of the health service, these changes are simply wrong.' His first contention is really a technical point in which he is simply reflecting that David Cameron's plans are more economically driven than in the interests of reforming healthcare to deal with future challenges, a key platform on which he is basing his reforms. This is true because, as lobbyists for the acute trusts have argued, private providers will 'cherry pick' services which have relatively cheap costs, receive higher demand and has larger profit margins. Therefore they are unlikely to provide the more major and serious services which attend to the changing needs of an ageing population. His second point about accountability plays on the fact that there will be a conflict of interest in the new structuring system where GPs are both commissioners and service providers. Thus, they are likely to have vested interests in where the money goes. Finally, he makes a symbolic point that the apparent 'privatisation' of the NHS is against the 'ethos' and values upon which the NHS has been guarded since its creation. Rather than seeking out an internal solution, he remarks that David Cameron has simply turned to the free market for a solution which will jeopardise the position and symbolic significance of the NHS in the public's eyes, in the nations identity and for every government to come.
Although the claim of privatisation is rather weakened by the fact that the costs of a service will continue not be determined by the provider but by the commissioner (which retains the principle of selection by quality rather than cost, as acute trust representatives maintain), a larger proportion of healthcare provided in this country will come from private companies. More ideologically important to Mr Miliband and representatives of acute trusts (all those who work in hospitals), private companies will reap profits from the taxpayer whereas, under previous NHS providers, all profits would have been reinvested within the acute trusts, a sour point for all who respect and value the principles of the NHS. Ultimately, despite all these criticisms, the point remains that we can no longer afford an NHS ridden with such inefficiences. Very much like Mrs Thatcher before him, Mr Cameron has decided this failing industry cannot be subsidised just because of the symbolic importance it holds in the minds of the nation, the free market must reign. And for all his just criticism, Mr Miliband has been unable to provide an alternative idea let alone a viable solution. Sticking to his ideological guns he will continue to hold the position that these 'cuts' are threatening frontline services and most importantly: jobs. So, politically, the debate returns to the age old partisan question: is unemployment a cost worth paying? Even if this 'listening exercise' is just a PR stunt, we know who holds power and we know who will say yes.
Subscribe to:
Posts (Atom)