Tuesday, April 04, 2006
Wanless Sees The Light
Back in 2001, Gordon Brown appointed Mister Derek Wanless to produce that massive two-part report on NHS funding. Its sole purpose was to justify Brown's planned "NHS" tax rises. Mr Wanless duly delivered the paperwork, and in his 2001 Pre-Budget Report, Brown told us:
"Mr Wanless' view is that the principle of an NHS publicly-funded through taxation, available on the basis of clinical need and not ability to pay, remains both the fairest and most efficient system for this country."
Fairest and most efficient. Unlike any other system of any kind anywhere in the world.
Now those of us who actually read the Report (that was me and...er...umm...) were unsurprised to find that the evidence underlying this extraordinary assertion was virtually non-existent. To start with, as Wanless himself noted, his review was "not set up to examine the way in which [healthcare] resources are financed" (First Report, para 4.1). He was merely asked to work how much we needed to spend- not whether that spending should be in the public or private sector. As he may or may not have realised, that decision had already been made by Commissar Brown.
On the efficiency of public vs private financing, all Wanless actually said was this:
"It is interesting to note that OECD work suggests that a greater share of public financing of health care is associated with better health outcomes" (para 4.13). But "The OECD notes that further work is required to explore this result more fully"(para 5.58).
You can say that again. The referenced OECD paper was an experimental statistical analysis by the improbably named Z Or, which appeared shortly after the Mask of Zorro. Z Or makes it very clear his paper is 'work in progress', and warns it would be "important to verify" his results. A statement that somehow didn't make it through into Brown's spin.
Fast forward five years, through the odd £100 billion or so extra NHS spending so far, and into the doubled level of spending going forward. Sir Derek is now an older and wiser man, shaking his head as he tells us:
'The government decided to pay people a lot more than was in the assumptions made in the report. Like night follows day, the money's not there to be spent on the other things. What they've finished up with now is using all the money - actually, slightly more than all the money - and they're not doing some of the things that were actually crucial: prevention, and productivity of the health services.'
On one level this makes your blood boil. Did he really believe his "assumptions" would ever be born out in practice? Did he really believe pumping up NHS spending would produce any other result than more bureaucracy and huge cost inflation? OK, he'd spent his previous career presiding over the terminal decline of NatWest, but surely he should have known something about the real world of socialist medicine.
Yet despite the boiling blood, you can't help feeling a little sorry for Sir Derek. Yes, he got his knighthood, and yes he's dined out on it ever since. But the guy's lost his innocence. It seems he really did believe he was a seeker after truth, a noble knight who was doing something for the good of all. A bit like that poor John Stalker in Northern Ireland during the 80s, or Lord Turner with pensions now.
Maybe these people really don't understand the answer is already written down on a scrap of paper in some minister's wallet.
Posted by Mike D at 8:20 am