Sunday 4 October 2009

Ten reasons to hate the Tories (8)

Point 8 from Cameron's Blueprint for Britain was this:

8. We will help restore discipline to schools by giving heads the final say on exclusions. Our NHS is special so we will protect its budget.

OK, the first part of that seems sensible enough, assuming they can somehow enforce it.*

* UPDATE: Oh dear. I had hoped that there would be at least one 'policy' which I could support, but OC has duly torn that policy to shreds in the comments.

The second part is drivel though. There is nothing "special" about the NHS. I contribute to National Death Service so I am very aware that it fails miserably on many occasions, but in terms of overall results it comes out much the same as most other European countries. Agreed, it is free or low-cost at point of use, but the same applies to most other European countries as well.

The only good thing to be said about the NHS is that, if you stripped away the one-third of its budget that it wastes on advertising, stop smoking campaigns, bureaucrats, quangos and internal wrangling, it is actually quite good value for taxpayers' money. But for the zillionth time, the healthcare debate is two completely separate debates: the funding side and the provision side.

On the funding side, it is broadly accepted that the taxpayer should fund a certain minimum level of healthcare, but that is no reason not to allow top-up payments for better treatment (whether that is paying for non-approved drugs, queue-jumping or anything else), whether paid in cash or via private, voluntary insurance.

On the provision side, there is absolutely no reason to assume that healthcare provision has to be controlled by The State. If the NHS (qua funder) is prepared to carry out an operation or a course of treatment for a certain price, why shouldn't patients be allowed to choose to have the operation privately and have the NHS cover the costs up to that price? This is pretty much what other European countries have; healthcare is largely funded out of taxes or "salary-based compulsory insurance schemes" (aka "taxes") but provided by competing providers - GPs are private (as they are in the UK) but larger clinics and hospitals are run by all sorts of bodies, such as charities, local councils, universities, insurance companies, churches as well as private partnerships.

It doesn't really matter who runs them, provided those at the top of the organisation know that if they mess up, patients will go elsewhere and they'll get the sack or lose their own money, and it works just fine.

1 comments:

Tim Almond said...

"OK, the first part of that seems sensible enough, assuming they can somehow enforce it."

I'm not sure how sensible it is. Yielding absolute power to someone who is controlling something that's publicly funded and run seems to me to be open to corruption.

Will a head of a school decide to not exclude a child who will boost their GCSE level stats while excluding one who will cause it damage?

Now, I don't particularly like the appeals groups either. They are people with power who do not have to suffer the outcomes of a disrupted child being brought back into the school.

Our old friend vouchers works here. Schools have an incentive to keep pupils in the school, but will consider the impact on other pupils (and losing their business) in so doing. And with greater competition, heads can then have absolute power to exclude.