Kevin Fong's Who cares?, an analysis of the NHS today, should be required listening for politicians both in London and Cardiff. The latest episode (on BBC Sounds here) hammers home the message that there is no single simple solution to its ills, and that the health service cannot be mended without also attending to social services. However, a subsidiary message from Dr Fong is that there have been too many top-down reorganisations (uniquely in the world of state health systems, according to an expert in the field) and not enough is devolved to local initiatives.
Cameron's Conservative manifesto of 2010 embraced the first message. There would be no new top-down reforms under a Conservative government. The Liberal Democrat manifesto did not go that far, but promised to remove unnecessary bureaucracy and there was an element of increased localisation. The coalition agreement reached a compromise in the area. In the event, all three aims were swept aside in a reorganisation under Andrew Lansley which surely made things worse. (Welsh Labour is not immune to musstunismus*; there were two GIG restructurings within the first decade of devolution, the second occurring before the first had been completed.)
When Labour politicians say that the politics should be taken out of any issue, it usually means that things should be done Labour's way. In the case of the NHS, it means the way of both Conservatives and Labour. Both large parties believe in strong central management. I would suggest that the Liberal Democrat philosophy of devolving power to the most appropriate level is particularly relevant to the health and social services and is therefore at odds with the two main parties' approach.
*Musstunismus: the belief that something - anything - must be done.
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Of the many major top-down reorganisations since 1948, probably the two most pernicious were the Griffiths reforms which introduced a new, additional, top tier of managers with their attendant support staff (or bureaucrats, if you prefer), and the introduction of the internal market in the late 1980s to facilitate the privatisation (or contracting out) of NHS services, which also kicked off a massive increase in bureaucracy and paperwork. NHS is still (mostly) funded from general taxation and (mostly) free at the point of delivery, but its partial privatisation of services continues to be a nice little earner for shareholders and CEOs of those private companies who managed to slice off a piece. Doubt if the present Labour party has the stomach for rolling any of this back.
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