Health policy debate – May 2005
The key issue this month has been the direction of health policy reform and the key questions: how far will the government go in involving the private sector and what is their long term view of private involvement in healthcare? Toward the end of the month, we began to get a glimpse of the answer. It seems the government is going all out to create a long-term market for health.
Can Labour sustain their health reforms with a reduced majority?
In the immediate aftermath of the UK election, where Labour suffered a much reduced majority and the public health minister, Melanie Johnson, lost her seat, many of the questions being posed by English journalists related to whether Blair will be able to sustain his reforming ambitions for the public sector. Will those who are not unremittingly new-Labour exert a larger influence and slow or change the direction of the Blairite reforms? Will the direction of health policy change significantly, away from market competition? ‘Will Brownites make common cause with the left?’ [Go to note 1] [Go to note 2]
The Economist is a firm supporter of Labour health policy and following the election published an editorial saying that ‘Mr Blair's hard-won health-service reforms need to be entrenched. He has shaken up an inefficient state-controlled monolith by introducing both an internal market - hospitals get paid per patient instead of through a block budget - and by letting the NHS participate in the external market - the state pays private companies to operate on NHS patients. But following through with those reforms will be hard with a small majority’.
Former cabinet minister Michael Meacher called for a roll-back of the market in public services [Go to note 3]. The more pragmatic Roy Hattersley hopes that Brown’s leader in waiting status will lead to a more clear vision for the role of markets than Blair has offered – a more strategic rationale for their use. He jokes that in World War II the budget was not divided equally between units with generals ‘told to compete their way to Berlin’. Rather different elements were carefully coordinated. Hattersley sees current policy as short-term, about clearing waiting lists, and neglects a long-term view.
Hattersley says he, like Brown, believes in a ‘mixed economy’, but says markets should be very clearly and carefully regulated. ‘I am certainly not going to line up behind those government critics who describe Ms Hewitt's proposal as the first step towards the destruction of the NHS. But it worries me that the government has changed course without a lodestar to steer by. Neither Crosland nor Tawney provided guidance about the private and public mix in the social services. So it would be unreasonable to expect John Reid (the true begetter of the new scheme) to be guided by more than the fashionable enthusiasm for markets. But Gordon Brown is capable of doing better. He might spend some of his waiting time treating the subject with the seriousness it deserves. [Go to note 4].
It is early days, but in the absence of a debate about the direction of policy, the signs are that in England reform will continue apace with the main aim seemingly to create a long-term market in the faith this will deliver responsive services.