Re-dis-organisation?

James Gubb, 20 September 2007

The Lib Dems have today proposed scrapping PCTs and SHAs and replacing them with elected local health boards, that would also be allowed to raise extra money for local services through a local income tax. The NHS must be shuddering at the prospect of yet more organisation. On the plus side, it would undoubtedly be a step towards solving the well-documented accountability issues currently besetting PCTs: dissatisfied patients would at least be able to kick out commissioners who aren’t providing a decent local service. But it is unlikely to be a satisfactory response to the NHS’ woes.

Two huge problems remain: firstly, the move is likely to actually increase the politicization of health care that has proved so damaging in recent years. It is highly unlikely that world-class commissioning will develop through electoral cycles and would make difficult, but necessary, hospital reconfiguration decisions (including closures) nigh on impossible.
But secondly, while this will supposedly bring health care decisions closer to the patient, what is said of patient choice? Most of the money will still be cascading down from the top and patient’s still won’t really have the power to vote with their feet.
Here, the reforms in the Netherlands are instructive. A better alternative would be to remove the geographical restrictions on PCTs and encourage competition between them, by putting money in the hands of the patients (i.e. health care through insurance-based schemes, not central taxation) and allowing patients to choose between the different health care packages offered. That would provide real accountability and real incentives for improved performance. The Lib Dems health spokesman, Norman Lamb MP, was, after all, quoted earlier in the week as saying: “Ninety-five per cent of taxes are raised centrally compared with the EU average of 60 per cent. Power resides where money is raised. This strangle-hold has to be broken.” Too true. So break it.