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“The National Illness Service”?!

Here’s one Lib Dem politician’s view on the Health and Social Care Bill 2011:

“We need to .. replace the National Illness Service that we currently have”

You can read my many other posts and note that I don’t quickly resort to expletives and such. But that kind of comment deserves a blunt response: [I disagree with you], Mr Kemp, [for being so smug]. No wonder the public doesn’t trust politicians with the NHS.

The UK has an efficient health care system that largely delivers high quality outcomes, considered by the World Health Organisation to superior to such countries as Ireland, Switzerland, Belgium, Sweden, Germany, Canada, Finland, Australia, Denmark and the United States (and FAR more cost efficient than the US). I’m embarrassed to find I’m in a party with a muppet who even thinks to use such a phrase as “the National Illness Service”, let alone write it down and publish it online.

(Note: that WHO survey is quite old, although they do track the individual measures. However, there’s no reason to believe things have changed significantly since 2000, particularly with the heavy investment under Labour in that time. The other countries aren’t perfect, either.) 

Then again, it was no surprise to find Mr Kemp is the Leader of Lib Dems in Local Government. I’m from Glasgow, where Labour’s stronghold on the council (they used to have 94 out of 97 seats before STV) was an excellent introduction to how local government can be just as condescending, closed to public input, and in hock to private or personal interests as central government. A pandering, self-aggrandising statement about how wonderful things will be with “local decisions will be made by locally accountable people based on local priorities and local opportunities” would be par for the course.

(Another note: I do believe in local government, subsidiarity, and so forth. But it’s not a blind faith.)

This is a long, complicated bill affecting a huge, complex organisation. Both the detailed letter of the law and the spirit of the legislators are important. Mr Kemp’s piece is light on detail and utterly lacking in good spirit; it’s depressing to have such pieces being written by a senior party figure.

The outcomes in a major change often come down to the soft factors: the weight given to executive sponsorship, the emphasis on risk management, the clarity of language detailing lines of responsibility. The Bill strikes me as weak on these counts. The Health Secretary is eager to hand off all these issues to a mix of quangos, consortia, local government and community representatives. If the reforms work as currently, it will be as much by luck as by design.

(Yet another note: it is possible, for instance as seen in France, to have a more hands off approach to the health service. However, success would depend on culture, and does anyone honestly believe the Tories are seeking the same culture as found in France? The Bill is transparently written to allow as much taxpayer money as possible to be channeled to the private sector. That doesn’t bode well for long term cost control, which is a fundamental goal of the reforms. Mr Kemp’s piece suggests governance by naïveté. It’s not reassuring.)

This is a bit of an incoherent rant, I know. But seriously, “the National Illness Service”? [How dare you].

Update 27/09/11: I really should hold my temper better, and have edited this article to make it more suitable for pre-watershed viewing. It reads funnier, too.

2 Comments Post a comment
  1. James King #

    You’ve completely missed what he’s trying to say. Richard Kemp believes that the NHS is good at treating illnesses, but not so good at preventing them – that’s what he means by a ‘National illness Service’, and i would agree with him. He doesn’t believe that the NHS makes people ill or anything like that.

    September 16, 2011
    • Jon #

      Hi James, thanks for the comment.

      However, you don’t seem to have thought it through. After the initial reaction against his lazy and insulting name for the NHS, here are the various reasons I decided to go with my comment that Cllr Kemp was being a [smug person]:

      – It simply is not possible to deliver both high quality AND cost efficient health care system without working at prevention as well as cure (hence my reference to the WHO’s comparative survey). “National Illness Service” does not reflect reality, no matter what Cllr Kemp “believes”.
      – He insultingly implies that reform rebels are unaware that “we need to address the real issues of an ageing population.”
      – He further implies we do not “accept that advances in medical and technical science can keep people out of hospital.”
      – The argument can be made that more can be done to prevent illness, but the nature of health care is that this will always be the case. That would mean it is always OK to refer to the NHS in negative terms. Therefore, it’s a lazy, disrespectful jibe.

      More fundamentally, you’ve ignored the substance of my post, which describes my concerns about the chances of the reforms preceding to plan. He believes the mix of bodies will work if we just get on with it. I do not; just getting on with it is one of the most effective ways to divert taxpayer’s money into corporate accounts.

      The NHS is funded through general taxation. Without a strong Health Secretary it’s demands on the Treasury are likely to creep ever higher as different stakeholders, including local councillors, push for ever higher budgets to please their local constituents. Remember that local, democratic accountability also leads to the temptation to buy votes. Also, local organisations are often weak or unskilled negotiators. PFI is still out there, waiting to eat up budgets.

      What is most at risk if costs are not controlled, and central government is unwilling or unable to increase UK health funding to the higher levels found in other European countries? Preventative services. Also, the free-at-point-of-care principle.

      The Tories have strong electoral and ideological incentives to push for a system whereby more taxpayers money goes to corporate interests irrespective of health outcomes, or where a system of fees is introduced. Lib Dem politicians should at the very least support the full legislative process to ensure such a future is unlikely. That includes review in the House of Lords.

      Instead Cllr Kemp seems to be enamoured of an imminent boost to his influence. It’s not clear he understands that “pushing our councils into adopting strong roles” is his day job. It’s the basic expectation. What would be impressive, however, is exerting as much influence as possible before the Bill is passed to strengthen the framework he will be working within.

      September 16, 2011

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