A Government worth having: Health policy

In the latest of our 'A Government Worth Having' series we look at health policy.  Top-up payments, patients being able to choose their healthcare commissioner and strong Matron-like figures are just three of the ideas suggested below. We've previously looked at new directions on economic and foreign policy as part of this series.

Simon Chapman: "The next Conservative government will have to face up to the overwhelming pressures that the NHS faces: demographics, dementia, obesity, technological and treatment advances, and rising expectations. These are already upon us and will only increase.  We will spend over £100 million on the NHS next year. That is highly political. At the moment there is no direct democratic accountability. An unelected NHS Board won’t make that better.  Tax funds are already insufficient to meet demand, although there is undoubtedly room for more effective spending. Decisions about priorities and rationing should be brought as close as possible to the people affected by them. Personal budgets (vouchers) and locally elected health boards are the levers. Co-payments are also inevitable.  Health reform must become a first term priority. The public are ready for honesty and candour – certainly more eager than the current Westminster consensus is prepared to allow.  We need to close the gap between health and social care. Joint commissioning and pooling budgets is one way forward. Bringing both under the strategic responsibility of one department is another: how about changing Andrew Lansley’s job title to Shadow Secretary of State for Health and Social Care? Before anyone shouts, I know that Local Authorities are responsible for social care, but they could be made accountable to a different Secretary of State.  Finally, if we want to improve confidence in the NHS, we need to make end of life care more of a priority. Over half of all deaths occur in NHS hospitals, and over half of all complaints about NHS hospitals concern dying and bereavement care. Hospices are often superb, but they cannot provide a complete answer."

Nadine Dorries MP: "I trained in an NHS which was run with consideration and discipline. The first concern of any nurse was to reassure her patient. To be aware that a hospital was a scary place, that we knew most things weren’t going to hurt and would probably be ok, but that the patient didn’t.  As a night nurse I spent many an hour sat on the edge of the bed of a sleepless worried patient, with tea and toast, listening to the dark worries keeping my patient awake. How long will I be off work? Will this affect my life?  I worked on wards which had dedicated ward cleaners and Auxiliary nurses who took pride in their wards and were in silent competition with the cleaner on every other ward in the hospital.  Nurses never wore their uniform outside of the hospital. A plastic apron was donned every time you treated a patient. Hand washing was automatic, cleanliness imbued throughout every aspect of the ward day. Visitors limited in order that a ward could be properly cleaned. There was no MRSA and poorly patients got the rest they needed.  Matron ruled, Doctors trembled, no nurse failed to give anything but her best. Everyone was accountable via a very clear line of command. Everyone knew who was responsible for what and when.  The NHS of today is driven by targets and process, not patients. Sometimes it feels as though patients are an inconvenience, lying in the way of clipboards and men in suits.  We need to make healthcare delivery totally patient focused. By remembering patients are there because they are vulnerable and ill and by giving patients respect and putting them at the top of the NHS agenda, by removing business suits and replacing with caring  uniforms, we may just begin to see a shift of priorities."

Andrew Haldenby, Director of Reform: "The issue of top-up payments for NHS care is waiting to be grasped by Government or Opposition.  This year a series of cases have proved that the existing rules are a classic example of how bureaucratic inflexibility can become cruelty.  Currently Norman Lamb is the only frontbencher spokesman who has argued for change bravely and positively rather than reluctantly.  A majority of patients and doctors are in favour.  Allowing patients to top up would be directly in line with the modern Conservative ideas of social responsibility and the post-bureaucratic age."

Dr Rachel Joyce, our PPC for Harrow West and a former PCT Director: "The NHS internal market failed because the “commissioner” is a poor proxy for the patient. Bureaucratic rules and targets make meaningful clinical and patient involvement in commissioning impossible, leaving managers to make decisions on what services are provided for patients.   “Successful commissioning” in the NHS is judged by performance against targets and rules. Success, in contrast, as judged by a patient is on good clinical outcomes and convenience.  Therefore much of the increase in health spending has been wasted on the administration of targets, resulting in high comparative costs but poor outcomes.  Patients should be able to choose who commissions their care. If GPs could choose their commissioning organisation, then patients could choose their GP practice (and therefore their commissioner) on the basis of outcomes. An independent NHS Board could be responsible for monitoring outcomes and quality via agreed indicators.  Patient choice of commissioner would drive down unnecessary bureaucracy and inefficient care, and would enable the NHS to provide comprehensive care that is not only efficient, but has world-class outcomes. "