Saturday, September 23, 2006

Still Waiting For Tesco Government

How very different from the home life of Sir Terry

So the rumours are true: just as the Doc foretold us in June, Brown wants to set up an "independent" NHS Board:

"PLANS to remove politicians from decisions on running public services, including the health service, are being considered by Gordon Brown as part of his manifesto for government. The Chancellor is looking at new ways of running government departments after the success of his decision to make the Bank of England independent in 1997, a move that restored trust in the setting of interest rates because it removed political interference."

But as we blogged here, there's a massive difference between setting interest rates and running the NHS:

"Healthcare would be much much more complex than the Bank of England’s task. In particular, the Bank has been set a single target - the inflation rate - which, give or take the odd bit of statistical goalpost moving by Gordo, is very clear and straightforward. But what target could he set for a Health Policy Committee?

To make Britain healthy? How healthy? How measured? And you do understand Mr Brown that you need to quadruple the health budget. And oh yes, you’ll have to ban fags, booze, unauthorised sex, super size BKs, the school run, slumping in front of the telly, computer games, and- especially- old age.

In reality a Health Committee would face a multiplicity of targets and a limited budget. It would be forced to make all those messy trade offs that cause so much difficulty today. Breast cancer drugs or IVF? Free nicotine patches or home visits from GPs? Free liposuction or stomach stapling?

And why would unaccountable "experts" be any better at making the right choices than politicians? Obviously the latter are pretty rubbish, but at least we can sack them."

This is a fundamental point: as we blogged here, electing the politicos is the only sliver of control we've got over the entire wobbly edifice. They're the ones who make all the promises and they're the ones we hold to account for non-delivery.

Instead, Brown wants to muddy the waters along the lines suggested by the ippr:

"Mr Brown is looking... to separate policy decisions by politicians from their implementation by Whitehall. In regard to the NHS, the Government would still set the budget and strategic policy but a new independent board would be responsible for management."

Well, fine. Sir Terry presumably reorganises Tesco's internal management structures from time to time. But the buck stays with him: his shareholders hold him to account for strategy, budgets, organisation, personnel, and- most of all- results. Why should we expect less from our ruling politicians? And the answer is- we won't

Brown's new wheeze threatens to make things even worse: so long as politicians set the budget, they call the tune, and no amount of organisational deckchair shuffling will change that.

The only sure route to reform is to break up our nationalised services, and put the spending power directly in the hands of customers. Just like with Tesco.

PS On another blog, a commenter has accused me of mostly talking "party political bollocks", strewn with contradiction. Well, just to be clear- I want serious reform in public services, but not this reform, which I think will make things worse. As for being party political, I remain deeply disappointed that no party has the cojones to propose and promote the radical choice and competition agenda developed by Reform, among others.

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