Nowhere to go
http://www.100md.com
《英国医生杂志》
Centre for Public Policy and Management, Manchester Business School
If you believe in a nationalised NHS, or if you want to see health care privatised, Kieran Walshe says you don't have anyone to vote for
So far in this election the debate on health policy has been reduced to a series of headline seeking but largely irrelevant issues, like methicillin resistant Staphylococcus aureus (MRSA) and hospital cleaning, matrons, health checks for immigrants, and new children's hospitals. These are manufactured disagreements that cover up the fact that the three main parties—and particularly Labour and the Conservatives—largely agree about the future direction of the NHS.
On money they all agree that the Labour government was right to commit itself to increase spending on the health service to European levels; they all support Labour's spending plans to 2008; and the only difference is that the Tories and the Liberal Democrats say they will spend even more. This government's lasting legacy will be that it had the courage to acknowledge that the NHS had been starved of resources and run on the cheap for much too long, and it embarked on an historic step change in NHS resourcing. In so doing, and in paying for it from general taxation, it torpedoed the longstanding argument from the right wing of the Tory party that the country could spend significantly more on health care only by moving to a system of social or private insurance to "top up" state funding.
On governance and structure, all three main parties agree that the NHS has been too centralised and that it makes no sense to try to manage the whole health service from Whitehall. Labour and the Tories want to create more (autonomous) foundation NHS trusts and to see more services run by independent providers. The Liberal Democrats want to give local authorities control over health service commissioning. They all want fewer centrally set targets and less monitoring and regulation. And all the main parties—to the despair of some health service managers, who have seen quite a few reorganisations of dubious purpose come and go in their careers—plan various reconfigurations of strategic health authorities and primary care trusts.
On the matter of choice they all agree that patients should be able to choose more freely where they go to be treated, both in hospitals and in primary care. Labour promises more choice for women having babies and for cancer patients. The principle that patients should be treated as enfranchised consumers rather than as passive recipients of services is universally accepted. On access they all agree that patients should have quicker access to diagnostic services and treatment, especially for serious conditions. Labour reiterates its promise of a maximum 18 week wait for referral, while the Tories promise that patients will be able to choose to go to any willing service provider and not be tied to the NHS at all. On provision, the main parties agree that NHS services do not have to be provided by government owned and run organisations and that other providers, including voluntary and non-profit making organisations and commercial companies, have a place.
The Tories feel, with some justification, that over the last eight years Labour has stolen many of their policies: marketisation, private healthcare provision, choice for patients, and so on. Labour has certainly travelled a long way from its traditional ideological territory in search of a way to preserve the fundamental values of the NHS—free care at the point of use, care in accordance with clinical need, care funded by society for society—in an age of individualistic consumerism and rising public expectations.
With this general consensus about policy, the electorate really doesn't have much choice. If you believe in a state run NHS or if you want to see health care privatised, you don't have anyone to vote for. And the focus of electoral attention therefore shifts from policy to implementation: who would do a better job of making things happen?
Here, Labour has the advantages of incumbency and can point to a track record of delivering lots of new hospitals and facilities, falling waiting times for elective surgery, and many other improvements. But the question is, regardless of what all the end-less statistics say, do the voters feel that Labour has delivered on its ambitious promises for the NHS? Have they noticed all the new investment?(Kieran Walshe, director)
If you believe in a nationalised NHS, or if you want to see health care privatised, Kieran Walshe says you don't have anyone to vote for
So far in this election the debate on health policy has been reduced to a series of headline seeking but largely irrelevant issues, like methicillin resistant Staphylococcus aureus (MRSA) and hospital cleaning, matrons, health checks for immigrants, and new children's hospitals. These are manufactured disagreements that cover up the fact that the three main parties—and particularly Labour and the Conservatives—largely agree about the future direction of the NHS.
On money they all agree that the Labour government was right to commit itself to increase spending on the health service to European levels; they all support Labour's spending plans to 2008; and the only difference is that the Tories and the Liberal Democrats say they will spend even more. This government's lasting legacy will be that it had the courage to acknowledge that the NHS had been starved of resources and run on the cheap for much too long, and it embarked on an historic step change in NHS resourcing. In so doing, and in paying for it from general taxation, it torpedoed the longstanding argument from the right wing of the Tory party that the country could spend significantly more on health care only by moving to a system of social or private insurance to "top up" state funding.
On governance and structure, all three main parties agree that the NHS has been too centralised and that it makes no sense to try to manage the whole health service from Whitehall. Labour and the Tories want to create more (autonomous) foundation NHS trusts and to see more services run by independent providers. The Liberal Democrats want to give local authorities control over health service commissioning. They all want fewer centrally set targets and less monitoring and regulation. And all the main parties—to the despair of some health service managers, who have seen quite a few reorganisations of dubious purpose come and go in their careers—plan various reconfigurations of strategic health authorities and primary care trusts.
On the matter of choice they all agree that patients should be able to choose more freely where they go to be treated, both in hospitals and in primary care. Labour promises more choice for women having babies and for cancer patients. The principle that patients should be treated as enfranchised consumers rather than as passive recipients of services is universally accepted. On access they all agree that patients should have quicker access to diagnostic services and treatment, especially for serious conditions. Labour reiterates its promise of a maximum 18 week wait for referral, while the Tories promise that patients will be able to choose to go to any willing service provider and not be tied to the NHS at all. On provision, the main parties agree that NHS services do not have to be provided by government owned and run organisations and that other providers, including voluntary and non-profit making organisations and commercial companies, have a place.
The Tories feel, with some justification, that over the last eight years Labour has stolen many of their policies: marketisation, private healthcare provision, choice for patients, and so on. Labour has certainly travelled a long way from its traditional ideological territory in search of a way to preserve the fundamental values of the NHS—free care at the point of use, care in accordance with clinical need, care funded by society for society—in an age of individualistic consumerism and rising public expectations.
With this general consensus about policy, the electorate really doesn't have much choice. If you believe in a state run NHS or if you want to see health care privatised, you don't have anyone to vote for. And the focus of electoral attention therefore shifts from policy to implementation: who would do a better job of making things happen?
Here, Labour has the advantages of incumbency and can point to a track record of delivering lots of new hospitals and facilities, falling waiting times for elective surgery, and many other improvements. But the question is, regardless of what all the end-less statistics say, do the voters feel that Labour has delivered on its ambitious promises for the NHS? Have they noticed all the new investment?(Kieran Walshe, director)