A story in the Guardian today looks at some immediate effects of the plan to turn NHS budgeting decisions over to front-line GPs. This has been a mantra of Lansley and Cameron: “empower the GP”. They tout it as an axiomatic good. But is it?
What is so desirable about transferring budgeting decisions to the hands of people who trained to practice medicine? After all, these are specialised management and accountancy activities you’d presume could be handled more effectively by centralised bodies of experts right? Well here’s Lansley’s justification for this wingnut scheme, try it on for size: GPs sit right at the apex of a pyramid of health care. Lots of complicated and expensive health care interventions may happen as a result of a GP’s interaction with a patient (an operation for example), but GPs currently don’t care about those cost implications. They just want the patient to get better so they’ll refer a patient for treatment, regardless of what that does to the overall regional or national health budget. “So,”, reasons Lansley, “what if we made GPs responsible for the entire budget? Then they’d think twice about sending patients for treatment! If a GP is responsible for every last penny of their budget and has the possibility of running out of cash half way through the year, they’ll make damn sure they pick the cheapest suppliers of everything and only dole out treatment when they absolutely have to. What’s more, these GPs know their patients inside out, so they’re best placed to make budgeting decisions that best fit the demographic of the folk they serve. Even better: we can do away with a whole bloated layer of accountancy and management civil servants now we’ve got our GPs to do that stuff . Massive savings eh? Ker-ching! Knighthoods all round?”
Well, no. To highlight the strangeness of this idea let’s apply the same thinking to another large organisation: Tesco is a similarly monolithic entity, operates stores all over the uk, has to make lots of complicated purchasing decisions about its supply chain etc. Let’s imagine Tesco decided to make its operations more efficient by proposing the following to all its local stores: “Here’s your budget for the year. You’re on your own. You’re now in charge of negotiating the best prices with the thousands of multi-national corporations whose products stock your shelves, contracting haulage, ensuring health and safety, maintaining your own building, attracting customers. The whole kaboodle. That’s all up to you now. You know your customers best, do whatever you need to do to be profitable. You’ll probably need to retrain some of your check-out staff and trolley-boys to be accountants and marketing executives and whatnot, but that’s your call. Yeah, we know it sounds scary but we’re certain the prospect of going bankrupt will focus your mind nicely. Also: you’ll be competing against all the other Tesco stores in the area now, so you’d better hit the ground running.”
Is Tesco likely to do this? No, absolutely not. They know that to run a large organisation efficiently you need a) collaboration not competition b) some centralised planning c) specialists to handle specialised tasks. Now I’m no particular fan of a corporate monster like Tesco but that’s how they got to be a market leader: by consolidating function, applying global strategies and taking advantage of economies of scale. It’d be a cold day in hell before Tesco announced a strategy of making its two thousand stores autonomous. It’d be seen as a move of jaw-dropping commercial lunacy.
So why is Lansley proposing this for the NHS then? Either a) he’s dangerously incompetent or b) he actually wants it fragmented and primed to fail. I suggest it’s the latter. This is an intentional strategy that covertly lays the groundwork for an ultimate goal. Think about it: if Tesco engaged in the suicidal scheme I outlined, how long would it be before the stores started individually going bankrupt? No time at all. What would happen then? They’d start getting bought up and bailed out by a variety of opportunistic corporations (in fact some of the more canny stores would invite in the big-boys pre-emptively, from the outset even). This will be exactly the case with GP commissioning groups in the aftermath of the NHS “reforms”. The private health care mega-corporations who helped draft this legislation are waiting in the wings, salivating at prospect of the killing they can make. They know this “giving power to the GPs” plan is a plan destined to fail and one they can profit richly from. What’s more, the GPs know this too. Thats why they, the very people supposedly “empowered” by this plan, are actively opposed to it. They know it’s a stitch-up. They’re being set up to fail, and they know they’ll be blamed when the greedy corporations swoop in to pick up the pieces. This is what Lansley wants: to carve up the NHS and hand it over to the private health care companies that have so richly funded his party. He can’t tell us that though. Privatising the NHS, whilst desirable to a minority of small-state idealogues, would be seen as a toxically treacherous act by the majority this country. Hence this convoluted scheme to “empower the GP”.
This might be the biggest privatization of state function the country has ever seen. We’re being told it simply isn’t happening, that we’re being alarmist, but yet here it is, unfolding slow-motion, right before our very eyes.