My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

Read my statement in full »

The Liberal Democrats Manifesto

Filed Under (Health Policy, Liberal Democrat Party, Manifestos) by Paul on 16-04-2010

One of the biggest problems for NHS policy is how do you maintain the vital principle of a NATIONAL health service that is paid for out of national taxation and is therefore fair across the country, with the necessity of actually commissioning and delivering that system locally. Whilst this is an issue in all policies- what is national and what is local- it is a much more central issue for the NHS because – well the tip is in the title – the public really want this service to be NATIONAL.

That means the public have shown time and again that whilst they want local input into the NHS, they are very angry at the local variations in service that have become known as the postcode lottery.

That is why the Liberal Democrats manifesto is so bold to challenge the idea that the NHS should only be nationally funded in their Manifesto.  

The Liberal Democrats usually promise radicalism but they rarely live up to that promise. In the small print of their manifesto on health however they have a truly radical policy, proposing elected local health Boards as their prime commissioning organisation (replacing PCTs). To go with the logic of a locally elected Health Board they make the proposal that  “Over time, Local Health Boards should be able to take on greater responsibility for revenue and resources to allow local people to fund local services which need extra money” .(page 43)

This is a truly radical proposal because it moves the NHS away from the principle that it has been working on for over 60 years – that the resources for the NHS come from central taxation. This policy argues that individual localities will be able to raise extra revenue for health services and by doing this moves away from the principle of National taxation and – as with all local taxation- builds a national unfairness into the funding stream.  

Taking 2 local health boards as examples. The Local Health Board in London’s Richmond and Twickenham would be in a better position to raise local money to top up their national expenditure for the NHS than say – the people of east Durham. This would mean that the NHS services in the former would be better funded than in the latter – thereby cutting across the principle of national fairness.

Crucially the Liberal democrats have the nerve to recognise where localism in their policies will lead them and in this case it leads them to fragmenting a funding system which has always relied on fair national funding as the core of its existence.

 With this major difference there are also some important similarities.

  • They too want to cut the size of the Department of Health – in this case by a half rather than the third of the other parties
  • They too want to extend access to talking therapies
  • They too provide the opportunity for choice from any provider
  • Commissioners should be able to commission from any provider
  • Reforming GP payments to improve incentives for prevention

Given they have not had a national majority in Parliament for so long, the Liberal Democrats are always looking to ways to empower localism in the policies. That is where their power and the activists have been.  They therefore have less ‘feel’ for the importance of the “National” in the National Health Service.

What will be interesting about the election campaign is whether the Liberal Democrats answer to what is usually seen as a boring administrative issue between localism and centralism is picked up for what it is   – a departure from the core founding and funding principle of the NHS.

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