It takes all kinds to make a world. But if you are one of those who believe that all conservatives are intrinsically bad people, or at best heedlessly negligent fools who wish to destroy the NHS, then please stop reading. This article is not for you.
I won’t argue the case for conservatism here; anyone who is interested in my views on that topic can read this or this or my recent biography of that still-towering figure, Edmund Burke. Nor will I argue my own case: those wanting to scrutinise my record can read my report on four years in Parliament here, my 2012 paper on the evils of PFI here, or my recent local leaflet on healthcare in Herefordshire here. And if you have not read Museji Takolia’s and my paper for the Centre for Policy Studies on healthcare statements, it is available here.
If I may, I want to begin where one should always begin: from a position of mutual respect, in this case as between Jonathan, me and you, the reader. But also from the further shared starting point that the NHS is an extraordinary human achievement, which we all love and want to support; that it is legitimate for anyone to offer ideas as to how to do this; and that those ideas should not be subjected to trolling and abuse but discussed in a courteous and rational way, as (broadly) Jonathan discusses the idea of healthcare statements.
Two key criticisms have been made of healthcare statements so far. The first is that they are a form of charging for NHS services, or open the door to charging; the second is that they cannot be implemented without harming patients who will see themselves as a burden. Let’s take each of these in turn.
The claim about charging is patently false. Of course this is a broader topic than is widely recognised; there already are some charges in the NHS, and some people would support charges on e.g. Saturday night drunks in A&E. But our paper discusses charging overall, rejects it in principle and points out there is no political support for it. And more than that: it undermines the rationale given by some people for charging. If people can be encouraged to use the NHS better through healthcare statements and other sources of information, then the argument that charges should be used to limit unnecessary demand doesn’t get going at all.
What about the second claim, which is Jonathan’s main focus? Is it true that healthcare statements cannot be implemented without harming patients who will see themselves as a burden? Again, we discuss this issue in the paper, and argue for careful testing and roll-out to make sure this does not happen. But the point is that this is an empirical question. It can be tested in different contexts, across different needs and different patient populations.
It may be that the conclusion is that healthcare statements should not be sent to patients; maybe they should be sent to GPs and discussed if needed with patients in the consulting room. But the only way to answer this and related questions is by careful and rigorous assessment. It may be that Jonathan is right; it may also be that healthcare statements liberate some patients by empowering them to use the NHS better using different pathways. But we can only know the answers by testing. It would be a very brave person who argued that more information and transparency about costs within the NHS was a bad idea as such.
Finally, Jonathan makes a very interesting point about Julian Tudor Hart, and the false but understandable historical belief that the NHS would be overwhelmed by demand. All I would say is that even if you believe that the laws of conventional economics do not apply to the NHS—and I have vigorously contested them myself in other contexts — you can still have a worry about different forms of excess demand on the NHS. Many people across the NHS have this worry today.
Take missed appointments. In March 2014 NHS England announced that “more than twelve million GP appointments are missed each year in the UK, costing in excess of £162 million per year. A further 6.9 million outpatient hospital appointments are missed each year in the UK, costing an average of £108 per appointment in 2012/13.” If true, this would imply a further gross cost to the NHS of some £700 million a year.
We can't pretend this isn't happening. And it would be good if this money could be used for the benefit of patients.
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