Saturday, 24 September 2011

'I know Evan has dim views on the Deity, but he actually does a passable imitation of an omnipresent being.'

Forget the slap stick knock about of some of our leaders-and let us draw a veil over Ms Teather's  embarrassing efforts- we in this neck of the woods were taken with the gentle humour of Southport MP John Pugh in the health discussion at conference on Wednesday.

Nobody reviewing the struggle to improve the Health Bill could have ignored the contribution of Evan Harris and John paid tribute to Evan's high energy efforts before going on to remark:

'I know Evan has dim views on the Deity, but he actually does a passable imitation of an omnipresent being.'

To put the quip in context here is the rest of John's contribution. I should start with a disclaimer in so much as this make not be the precise wording John used in delivering his contribution but it is pretty close.

Delegates as the strange cumbersome , heath robinson affair that is the Health and Social Care Bill lumbers its way into the House of Lords we perhaps should look back and give credit where it is due

To those activists like Charles West who rang the alarm bells

To Nick and his team for their intervention

To Shirley

To Paul Burstow for his almost saintly calm and patience under fire - much of it what the Americans ominously call-friendly power

And to Evan for his powers of mobilising opinion.  Briefing media, circulating to delegates, helping 38 degrees set questions,crafting amendments, lobbying the party committees.

I know Evan has dim views on the Deity, but he actually does a passable imitation of an omnipresent being.

And finally Andrew Lansley

And why?

Because he awoken the country to the ultimate absurdity of a 20 year experiment with the NHS

He has endeavoured to take the Blairite model for the NHS to its logical conclusion

You take all the public service component- parts hospitals, clinics etc -turn them into free standing economic units - barely distinguishable in motivation and character from private firms

You oblige them to compete under regulation for business

And you stump up 100Bn in cash allow someone first GPs and quangos and then patients- sorry the consumers- to buy the healthcare they need OR want.

The state changes from a provider to shopper - sorry 'a commissioner'

And you have a market.

You will have all sorts of things in a market sharp elbows,innovation,the unpredictable rise and fall of enterprises.

What cannot be guaranteed in a market is equity, people getting what they are entitled to, the wisest and most efficient use of public resources, service above profit, properly integrated health services

And so we ban price competition, we struggle  to prevent cherry picking , we create a multi million pound organisation (MONITOR)  to control the market and keep changing its remit,
We massively increase transaction costs and bureaucracy by having one half of the NHS bill the other half and haggle over tariffs.

It is both comical and sad to see the NHS deny itself huge saving on procurement, bureaucracy, estate and running costs because all its branches have to behave like separate businesses- to compete

It is comical and sad to see integrated pathways of care and collaboration, the sharing of experience, know how snarled up by competition regulation

It is absurd and unhelpful to set the NHS and private providers at loggerheads by making the private sector no longer a partner but a rival.

We are like the motorist who has taken a wrong turn on the motorway and are doomed to travel on for a while forlornly waiting for the next direction sign.

We have ended up with a bill which aspired to finally separate commissioning from providing by  making the NHS biggest provider the GPs do the purchasing with all that conflicts of interest involved

We have a bill that aspires to pass power down,  but centralises more commissioning in the hands of an unaccountable commissioning quango

But perhaps we have learnt that the answer to getting good ,efficient public services is not a matter of constructing bizarre, wasteful state managed markets that have none of the virtues of real markets  and most of their vices- but the Liberal solution..

Genuine,Working ,Two Way,Accountability-Local and national- bridging the yawning gap between those who provide and serve and fund  and those who recieve and  benefit.

A system driven by ethics not by the bottom line.

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