Lib Dems recommend privatising the NHS?
‘Co-ownership of health care providers’, ‘Direct payments on behalf of patients’ ‘Individual budgets’, ‘Payments for results’, ‘Local Health Boards’
Does this sounds like a Lib Dem healthcare manifesto to you? No, me neither – in fact, reading through the document by Norman Lamb, it strikes me that much of what he is advocating is eminently sensible and in fact very much in line with what the Tories are proposing.
The only difference is that only 5 times in the entire 48 page document, does he use the word Private. It seems to me that the core values of this document are the same, but it has been quite neatly ‘spun’ by the party to ensure that they aren’t seem to be endorsing the ‘privatisation of the NHS’.
Ideas such as co-ownership offer a fix to the issue that incentives in the NHS are not properly aligned and although he talks about not for profit organisations and co-owned trusts, he stops short of recommending the use of private companies to achieve the same thing.
The issue with this fundamentally is that although employee owned trusts will achieve better alignment of interests, it will be difficult for these enterprises to grow to the levels required to really achieve significant economies of scale. If we take this idea and combine it with the suggestion of GPs acting as commissioners, able to manage the patient pathway in a Kaiser-esque ‘managed care’ scenario, then surely it makes sense to allow the growth of organisations that specialise in specific types of care? Maternity services could be such an example where an expert company in the field is able to offer a managed service for the GP. Equally, this ties in nicely with the ‘direct payments’ or ‘individual budgets’ idea which would give patients the choice of where to spend their voucher for treatment. Competition at a national level between providers as well as at a local level will surely increase the quality of service provided and ensure providers remain as efficient as possible.
To manage this all effectively however, the Lib dems are correct in their assertion that the NHS IT system must change. It must become more oriented around pathways rather than episodes and must be intelligent enough to spot and prevent ‘failures’ in the system to stop patients falling through the gaps.
GPs cannot be expected to individually case manage every patient and if hundreds of further organisations are not to be created with the sole purpose of managing patient journeys, technology must be employed to ensure that proactive alerts and reminders are used where possible, combined with the effective delivery of this information into the hands of both the GP and the patient.
Furthermore, It must critically allow for the linking and joining up of services across providers and in particular those in social and primary care – not only because this is where the majority of care takes place, but also because it is here that the greatest savings can occur. Keeping patients out of hospitals with the intelligent use of technology ought to be the goal. This can be through the simple realignment of payments to GPs for measurements, to payments for improvements (ie, not pay GPs to ask people whether they smoke, pay them to get them to stop smoking!) and the efficient tracking and publishing of outcomes to measure performance of clinicians and providers.
This will ensure that excellence is rewarded by increased patient volumes (who will have access to this information in both the Tory and Lib Dem system) and that the overall health of the nation improves as a consequence.
I could go on for hours about this as this is a topic which is clearly of huge importance to me and those that I work with, but I will stop for the time being. Suffice it to say, nomatter the results of this next election, the challenges facing the next parliament will be huge and I look forward with interest to seeing what lies in wait for us.
