Thursday, April 07, 2011

Andrew Lansley's "natural pause" is welcome, but health reform is still needed

The Coalition's “natural pause” over its Health and Social Care Bill is to be welcomed. Those who would decry it as weakness are probably wedded to a faulty model of what governing should be like.

Either they are Bennites, who see a government coming to power with a popular mandate for its programme and then implementing every detail of that programme come what may. Or they are Thatcherites, who believe that programme should spring fully formed from the head of the leader and be implemented with just the same thoroughness. In the latter case at least, the more the programme is opposed by the wider public the better.

So how should we make use of this pause?

As I have said before, I am sympathetic to the thrust of the bill. After 13 years of Labour governments in would be surprising if there were not a need to NHS services more responsive to individual and local circumstances.

As I have also said before, my major problem with the bill as it stands is that it makes too little provision for public accountability. But then that is a problem with the way the NHS is currently organised too. So we need more democracy in the NHS, and that need will certainly not be met by simply handing power from managers to GPs.

This emphasis on public accountability is one of the changes urged by the Social Liberal Forum. However, I am sympathetic to Don Falchikov's view that there is a tension between this desire for accountability and the Forum's demand for "a fully comprehensive and free health service, with no gaps and no new charges".

Because if meaningful democratic accountability is to exist it must take place at a local level. And if it does take place locally then different decisions will be taken in different places. Will this entail an NHS that is not "fully comprehensive" or one with "gaps"? The answer is not clear to me.
My suspicion about the Social Liberal Forum is that its radicalism runs out at just the point when it threatens to question the Guardian's editorial line. But maybe I am being unfair.

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