A Liberal NHS - an opinion article for Liberal Democrat Voice

This article first appeared on Liberal Democrat Voice on February 17th 2010. My other articles for ldv can be found here.

As people who know me well will tell you, I've always been something of an idealist, daydreaming about some abstract political philosophy whilst everyone else deals with more pragmatic concerns - or 'living in the real world' as I believe it's known. I make this point as what I'm about to write alludes to an apparent confluence - potentially at least - of strands of abstract political thought and practical everyday policy that I believe should gain prominence as the general election approaches.

First of all let's deal with the practicalities (unusual for me but there you go...). Last week Norman Lamb MP launched The NHS: A Liberal Blueprint, a Lib Dem policy briefing on the future of the NHS. Accompanying the launch of this paper was an article in the Guardian, detailing not only the specific policies but the overarching principles guiding them. There is a great deal to applaud in both, not least the recognition that large-scale and indiscriminate slashing of the health budget would lead to cuts in 'public health programmes and mental health services, hitting the most vulnerable the hardest.' Another welcome note was the way in which local democratic control over health services would make practitioners and service providers accountable to those using their services – a model that could well be applied to many public services, including utilities and transport.

The majority of both the policy briefing and the Guardian article focus on the fact that despite record government investment in the NHS, far too much goes to waste before reaching the coal face. Allow me to quote verbatim from the introductory paragraph to the policy paper:

A lot of money has been invested in health in recent years but too much of that has been wasted on bureaucracy rather than investing in frontline services. Doctors and nurses are forced to spend too much time trying to meet government targets rather than caring for patients. And government ministers make decisions about closing local services from the comfort of their offices rather than facing the people it affects.

It's worth emphasising that every word in this paragraph is true – despite the deployment of mountains of cash, far too little of it is being used for frontline clinical services. And yes, top-down targets and paperwork do impinge on healthcare professionals' ability to care for their patients. In fact the policy briefing goes on to discuss how unaccountable Strategic Health Authorities would be abolished, as an example of tackling the bureaucracy – a good thing, arguments over how the NHS' vital population-level health planning role would function aside. So I don't have a problem with what's in the paper as much as with what isn't – if we accept that the large sums of money thrown at healthcare are not being used effectively, what is the hulking great elephant in the room we're ignoring?

Norman himself gave us all the answer as it happens, in the form of a strong press release just a few days later. Detailing the enormous burden that the Private Finance Initiative has left the NHS with, this press release was picked up by a few media outlets including London's freesheet Metro, which said that the NHS was liable for paying £63bn for PFI projects 'worth only £11bn.' Now at this point I want to make clear that this isn't some ideologically dogmatic rant against private involvement in the provision of healthcare. For reasons I won't go into – some of you may be eating as you read this – I had to have an endoscopy this morning, and to speed up the process I was seen by a private hospital in Hertfordshire. Whilst my personal experience was pleasant and efficient, I was left wondering how much more this approach had cost the taxpayer. Allyson Pollock, author of NHS plc, may well know, much as she knows the impact PFI bills are having on frontline services across the health service.

As an alternative to the disastrous PFI, Norman's press release mentions setting up an infrastructure bank to ensure high levels of investment whilst retaining the fairness and accountability that comes with public-sector service provision. This is worth reiterating – the Liberal Democrats are proposing to create an infrastructure bank, to give us an alternative funding model to the PFI which threatens to cripple schools and hospitals with unaffordable repayments. And yet, throughout the policy briefing and the accompanying article, there's no mention whatsoever of what to my mind could be the single greatest factor in preventing the effective delivery of healthcare in this country – the insistence that PFI and private, for-profit providers become more and more integral to the ethos of the NHS.

In many ways the policy paper provides a strong, liberal model for how healthcare can be effectively delivered – locally accountable, flexible and with high levels of excellence for all. And yet I feel that we may have missed a trick as a party with the general election coming up – here is a policy that truly differentiates our plans for the NHS from the other parties, that puts fair funding at the heart of a fairer service – but no mention of it in the policy briefing, nor, disappointingly, of healthcare reform at all the draft agenda for the imminent spring conference. As far as this policy paper goes, then, it does well – trouble is, it just doesn't go far enough.