October 19, 2005


A real danger of damage: Ideology is driving the health service reforms, rather than New Labour's principle of 'what works' (John Denham, October 19, 2005, The Guardian

Rows about new government initiatives are raising sharp and difficult questions about policy-making in Labour's third term. It is difficult to argue with Tony Blair's conference speech: "Choice is what wealthy people have exercised for centuries ... For Labour, choice is too important to be the monopoly of the wealthy." Many party members felt this was a case for choice with which they could be comfortable.

And so they should. It's not an issue on every doorstep, but the demand for choice is gaining strength. Today's minority demand will fast become a right the majority take for granted.

The sterile debate on the value of choice is obscuring the real issues. There are many types of choice and different ways of making them available. The problem is the way the government is doing it. Patricia Hewitt recently urged us to concentrate on the principle, not on the technical detail. But the detailed changes are built on dubious assumptions.

In 2003, the prime minister argued that "competitive pressures and incentives drive up quality, efficiency and responsiveness in the public sector. Choice leads to higher standards." Put in the gentlest way, that is a contentious statement of ideological faith. It is not grounded in any clear evidence, but the belief that it might be true is driving change in every corner of the NHS. Perhaps enough patients will choose from enough hospitals to influence the standard of provision. Perhaps the impact will force all hospitals to improve their care. But, equally, it might leave some NHS hospitals going bankrupt under the strain of providing the high-cost operations that no one else wants to do, as the Audit Commission has warned.

Greater competition may be so effective that it is worth subsidising new private clinic provision with inflated payments, centrally imposed contracts and seconded staff. Is "invest now and save later" worth it? When parts of the NHS are stretched, it is an expensive gamble to give money straight to the private sector without letting the NHS show what it could do with the money.

In Britain it makes Mr. Blair radically First Way to his allies. In America the same ideology makes George W. Bush radically Second Way to his allies. In reality, it's the Anglosphere-wide compromise that marks the Third Way, regardless of whether those leading it are in parties of Left or Right.

Posted by Orrin Judd at October 19, 2005 8:24 AM
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