David Cameron has just announced that the government will revise their plans for shaking up the NHS: a little tweak here, and little tweak there. Unfortunately Mr Cameron's party has form in this area. JacquesO's livre du jour is Christian Wolmar's book on rail privatisation and although there are huge differences, there are things that chime with the current debate in healthcare (I know I'm not the first to make this comparison).
The first issue is the unquestioned assumption that competition of any sort is an unalloyed good and any opportunity to introduce it should be taken. This overrides any rational or systematic assessment of whether competition actually makes sense in the context in which it is introduced.
The second is the presumption on the part of ministers and civil servants that they can contrive a highly regulated, pseudo market in a complex domain of which they have little real knowledge that actually works, and delivers the stated benefits without too many disbenefits or perverse incentives. Certainly the rail comparison indicates that the challenges of such a task is beyond even civil service high flyers.
The third is the unseemly haste with which poorly thought through policy ideas have been developed and converted into similarly poorly drafted legislation, the controversial nature of which results in much chopping and changing for the sake of political expediency.
The fourth is the impression (correct in the case of railways) that the government is making things up as it goes along.
Given this context it's hard to have any confidence in Mr Cameron's statements on the NHS, however well intentioned. As for the actual results on the ground of Mr Lansley's botched reorganisation, it's anyone's guess.
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