Lansley preaches to the nation

Faced with hostility from such unlikely quarters as Conservative Home, ‘the unpopular and unnecessary NHS bill could cost the Conservative Party the next election, Cameron must kill it‘, The Mail on Sunday who exposed, ‘The firm that hijacked the NHS, The Spectator ‘Lansley’s health problems are beginning to look terminal’  and ‘Lansley’s battle should’ve never been fought’, not to mention ‘bonkers’ Baroness Warsi’s farcical defence of the health bill…

… it was no surprise that Lansley felt obliged to come to his own defence. He chose to do so from the subscription-only pages of the Health Service Journal (though you may be able to access it here) where he laid his defense down like an evangelical preacher speaking to the faithful. The self-satirising, “There is little we can learn from examining the past”, “There is nothing to fear from competition” and ” in any other sector, it is the thousands of individual decisions to adopt a new technology – from, say, cassettes to compact discs to mp3 players – which combine to sweep away less effective services” Really? … Healthcare is not like any other commodity.

… is only eclipsed by the evangelising tone of his sermon. The parable of how the tape-cassette became the MP3 player was even proselytised by Rentoul the faithful from the Independent.

Actually, this was further eclipsed, but fortunately non-HSJ subscribers are protected, by the astonishing number of anonymous comments that could find ‘nothing to disagree with’ or said, ‘he makes some very good points’. It is this non-thinking that would lead me, if I had less respect for my head or the wall, to hit one against the other.

There are many types of competition in the NHS with hundreds (perhaps thousands) of awards for quality, innovation and research. One reason why critics object to competition as envisaged in the bill is because it is specifically about competition between hospitals and providers for patients and competition between patients for doctors. Quality and innovation may, or may not have anything to do with what it takes to attract patients. The choices patients make about their care are very sophisticated and quality of care is just one of many considerations. The health bill has a severely limited view of patient choice and competition; it views them as market-levers. The problem with this is summarised by the Inverse Care Law which states,  The availability of good medical care tends to vary inversely with the need for the population served.  This inverse care law operates more completely where medical care is most exposed to market forces, and less so where such exposure is reduced.

Another reason I and other critics have been campaigning so hard and long against the health bill is that it lacks any evidence. When the bill was announced my immediate response was, ‘Extraordinary changes require extraordinary justification backed up by extraordinary evidence’ . As Paul Corrigan, ex-health advisor to Tony Blair has blogged to death, the government have failed to provide a convincing reason for overhauling the NHS. And Ian Greener today responded with eight myths about NHS reform.

If the NHS was a patient in need of treatment and Lansley was a doctor he would be from a lost generation who learned their communication skills from Sir Lancelott Spratt, for whom a reasonable question about the risks of major surgery (or, ‘do I really have nothing to fear from competition?) was answered with, “Don’t worry my good man you won’t understand our medical talk”

Lansley is true to his faith, he has learned little from the past.