Monday, September 25, 2006

Worst Of Both Worlds

Aren't politicians great. The more we hear about Smiler Brown's "independent" NHS board, the more we can see its underlying purpose really is to gull us voters into thinking that the politicos are withdrawing from running things.

His problem is that the penny is dropping- in an age when we increasingly hold all politicians in contempt, slowly, dimly, we're starting to ask why they should be in charge of so much? And the end-game is clear- both for our public services, and, sadly, the career prospects of our politicos.

Somehow, the voters have to be deflected... Hey- I know! Why don't we have an independent NHS board! A direct parallel with the independent Bank of England- coincidentally, the only thing I've ever done that hasn't ended in tears!

But most independent commentators are pointing out that running the NHS is much much more complex than setting interest rates (see our view here), and that a better comparison would be with our old dysfunctional nationalised industries, or with a super-quango. Both are disastrous precedents- cumbersome, bureaucratic quagmires, run by placemen, and wholly dependent on their political paymasters for all the decisions that really matter- like funding.

In fact, such structures can easily give us the worst of both worlds- bungling around in no-mans land between the wishful thinking of politicians and the harsh realities of commercial existence.

There's an excellent example in the new private medical centres (independent sector treatment centres- ISTCs) contracted by the NHS to bulk supply standard procedures like hernia operations and day-surgery orthopaedic, gastroenterology and urology procedures. It turns out most of the 20 centres opened so far are falling way short of their operating targets- doing only just over half of their targeted operations.

Unfortunately, because the NHS is such a rubbish shopper, we are contracted to pay the ISTCs whether or not they actually do the operations. And as is usual with these public-private deals, the contracts are long-term, and those let so far have a value approaching £2bn.

You can't blame the commercial operators- the private sector works on the basis of contracts, and nobody in their right mind deals with government unless the contract is absolutely watertight, to protect their interests once the inevitable political wriggling and welshing gets going.

But government operates to a different beat, where political survival always takes precedence over financial good housekeeping. £2bn wasted on services we may not get is but a drop in the ocean compared to the Grand Sweep of that tiresome political narrative on NHS reform.

Gordo's NHS board is simply another example of the same thing- driven by politics, not by our need for better healthcare, it will end up costing us dear.

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