In June last year, I posted an insight to solve the NHS problem which, given the cost of the NHS is forecast to increase from £130bn in 2015 to £260bn in 2030, is a big one.
At the time, David Cameron had stepped in and put the Bill on ‘pause’.
This must have been a bore to Health Secretary, Andrew Lansley, who had dreamt up a Bill without, it seems, due research or consultation with the medical profession.
Today, we now find this Bill, more formally the Health and Social Care Bill, is back in ‘forward’ mode or, more accurately, ‘slow forward’ mode.
This may be due to the fact that it has become so long, so complex and so unwieldy that apparently only Mr Lansley understands it (and, perhaps, the sad civil servant at the Department of Health who wrote this explanation).
In my experience, the complexity and incomprehensibility of a problem is in inverse proportion to the effectiveness of its solution, especially when politicians are involved.
So what was wrong with my idea?
Well, I do not think there was anything wrong with it at all. In fact, I believe it is more pertinent now than it was when I revealed it last June. That is why I would like to remind you of it now.
Before I do this, and by way of keeping you in suspense, let us try and identify the core issue.
For, as is quite often the case, if you can digest all the verbiage and argy-bargy down to one core insight – or even one word – then it becomes possible to re-build the issue in a much simpler way. To this end, as you may know, I am a great believer in Lord Saatchi’s mantra ‘Brutal Simplicity of Thought’.
In the case of Mr Lansley’s Health and Safety Bill, there is one word around which all our confused and inadequate politicians are dancing.
And that word is competition. They just cannot get their heads round it.
The LibDems are against competition in the NHS. This must be true because the Daily Mail says so. Labour are sort of against competition in principle but they cannot say so because they introduced it when they were in Government. The Conservatives believe in competition but they are trying to find a set of words that says so but does not say so, if you follow.
So they are all dancing on the head of a pin, and discussing forestfuls of paper called a Bill (and what a bill!) because none of them are prepared to say what they really mean.
Let’s go back to the word competition and see what all the fuss is about.
Well, again, it is simple. What they don’t want is private companies making loads of money out of public funds as, for example, some care homes have done – and especially not out of the public’s ill health (i.e. the NHS).
So here is my thought. Haven’t the Banks provided the answer? As I said last year:
‘Socialism, like the Berlin Wall, has bitten the dust. We live in a world of ‘free market economies’. But we now know that we cannot let ‘free’ markets run uncontrolled.
As we have seen in the banking crisis, there is a Role for Government.
I bank with NatWest, owned by RBS, 84% owned the taxpayer (us). But do I blame the Government for any issues with NatWest?
Of course not. I go to my local Manager. Unlike the NHS, the Government do not manage NatWest. We – you and me – just own it. And it seems to be doing OK (now).
So here is my solution. Let private companies manage NHS services. Feel free. Tender.
In return, we want 30% of the equity and a seat on the board. Our directors will not be civil servants but experienced businessmen. They will abide by a strict public-service code. And be accountable for our best interests, financially and in delivery.’
Do you know what happened after I posted this? A very senior Tory contacted me and said:
‘I love the idea but the problem is finding large enough talented populations in Government who understand business and in business who want to work in Government! Also let’s not forget that drugs companies, builders and most of the medical profession make money from sickness.’
I did not reply to these two objections.
To the first, I would say that I am not aware of any trouble recruiting Mr Hester for RBS. I am sure, with the right financial motivation, businessmen would be queuing up to run such companies – especially as business ‘sales’ would be served up to them on a plate. All that would be required would be efficient management rather than chasing customers.
To the second point, if our politicians and civil servants really cannot find a way of defining the difference between a public service and a plumber, then we all need to see the doctor.
So there you go. Don’t worry about ‘competition’ in the NHS. Just invite commercial operations to tender for the business and, in return, demand a piece of the action.
How long should that take to work out?