A leader in The Independent this week made the following point:
It is widely agreed that an unprecedented injection of public funds into the NHS over the past eight years has failed to deliver the expected improvements. This is because the funds were not matched by wholesale reform of the system. Health-care workers were left to carry on delivering services in the same old way, rather than being forced to become more efficient and responsive to patients' needs...
Well, I couldn't agree more. Their leader was in response to the Conservatives' latest green paper, launched this week and entitled Delivering Some of the Best Health in Europe: Outcomes Not Targets. The gist of the paper was that central-government targets distort clinical priorities and prevent innovation, and should be scrapped.
That's certainly a welcome idea. Targets make healthcare providers accountable to Whitehall, when they should actually be accountable to patients. Targets also generate bureaucracy and encourage 'creative accounting' – effort and resources are expended on jumping though hoops, when it should be devoted to medical care.
Many welcomed the Tory proposals on this basis – but plenty of others moaned that they were not radical enough. I don't necessarily disagree, but the Conservatives' plans do in fact go much further than most people realize.
Essentially, what they want to do is give doctors and hospitals much greater independence, establish a comprehensive payment-by-results tariff, allowing unrestrained competition between the private sector and NHS trusts, and then allow patients to choose freely between providers. Patient choice would be underpinned by the publication of healthcare outcomes, so that competition would really be directed towards higher standards. All good stuff.
Regrettably (albeit understandably) the one area the Conservatives won't touch is healthcare funding. Services will continue to be free at the point of use, and financed out of general taxation. That's a shame. Supply-side reforms like the ones outlined above will undoubtedly drive up standards, but they can only go so far. And without funding reform, excessive political interference will continue to be a very dangerous temptation.