Monday, February 18, 2008

Lansley shrugs his shoulders....

....at our balkanised health service.

A couple of weeks ago Conservative Home asked for readers to post up any questions they may have had for Andrew Lansley, Shadow Secretary of State for Health.
Here was mine:

“A recent report from the NHS Confederation stated that devolution has created four different NHS systems in Britain.

Do you agree, and if so, how would you attempt to remedy the obvious inequities arising from this situation?”

"Jake" later expanded on my original and this was the question finally posed to Mr Lansley:
There are now effectively 4 separate NHS's. The NHS's of Scotland , Wales and NI have their own governments to shout for them plus they have a loud say in the British government. The English NHS has no representative body and is left to the cynical mercies of the British government which is dominated and led by Scots committed by oath to the paramountcy of Scotland eg Brown and Darling.
What are you and your party planning to do about this fundamental discrimination against England?

Andrew Lansley’s answer:
I agree that the NHS in England has been subject to the cynical mercies of the Labour Government. However, health is a devolved issue and more expenditure does not mean better outcomes. The disappointing reality is that right across the NHS we are not getting value for money. In England, we spend the European average on healthcare but the outcomes - for example five-year cancer survival rates – are amongst the worst. We need to increase efficiency and improve outcomes, that’s why we brought forward the NHS Autonomy and Accountability White Paper.

I don’t how Jake feels about that response, but to me it’s complete cop-out.
It’s exactly because "health is a devolved issue", when it should never have been, that we now have effectively four health services. It’s because health is a "devolved issue", that there are fundamental differences in the level of basic "service" provided, depending on which of the four NHS’ jurisdictions you happen to find yourself. Yes, by all means, increase efficiency and "outcomes" "across the board", but that still wouldn’t remove the inequities that the "devolution" of health will always inevitably deliver.

A National Health Service should mean just that, a Health Service for all the nation and you have the right to expect equal and fair treatment wherever you may live in that nation

7 comments:

kensei said...

Why shouldn't health have been devolved? Why is centralisation a good idea? Why shouldn't countries with different health risks and priorities, focus on different things? Why if there is popular demand for spending more money in health in Scotland, should they be denied because England does want it?

I don't expect an answer, because this is a rant without thought or basis other than Unionism.

O'Neill said...

And it's fair that one person who pays exactly the same amount of tax and social security payments, as another person in that same nation, be denied exactly the same health benefits?

You're an Irish nationalist, I don't expect you to bother too much about the inequities of the health system when it may well contribute to the destruction of the UK which you have no loyalty to anyway.

Lansley, on the other hand, is theoretically a Unionist. Which is why his answer was so pathetic.

kensei said...

And it's fair that one person who pays exactly the same amount of tax and social security payments, as another person in that same nation, be denied exactly the same health benefits?

You pays your money, you takes your choice. If the people of Scotland vote for as Government that says it will spend more on health then yes, they should. The money coming out of the block grant is fixed. It will have to come from elsewhere. If taxation is devolved there is more of a case, because the taxes will not be the same.

You're an Irish nationalist, I don't expect you to bother too much about the inequities of the health system when it may well contribute to the destruction of the UK which you have no loyalty to anyway.

Correct, it's more than no loyalty: I believe the UK would be better off as separate nations. But this is irrelevant to the point,a dn do like the NHS. I am a democrat, and also understand that decentralisation is not the same as destruction, necessarily. If anything, power should be further devolved down with in regions.

This will create variation, true, but also hopefully a widespread improvement and an NHS more tuned to local needs.

You haven't answered my questions, because you haven't got any decent answers. Like Unionism in general.

O'Neill said...

If taxation is devolved there is more of a case, because the taxes will not be the same.

If you mean that if taxation is devolved, then there is more of case for Scotland/Wales/NI developing their own autonomous health services, then I agree. Once tax raising is devolved, the UK and by extension,the NHS will have effectively ceased to exist anyway.

I am a democrat, and also understand that decentralisation is not the same as destruction, necessarily. If anything, power should be further devolved down with in regions.

This will create variation, true, but also hopefully a widespread improvement and an NHS more tuned to local needs.


France is a bigger nation population-wise and has at least as many diverse regions as the Uk. It manages quite well on one health service,regularly voted the best in the world and we even ship some of our patients out there. It does have a health-board system similar to the UK and if, for example, there are is a higher level of cancer found within a certain region, then resources are directed towards that area. That may well be regionalism, but it is logical and ethical regionalism.
The regional “variation” in the UK however occurs largely on cost to patient (ie prescription charges) and availability of drugs. It is immoral that a sick person in one part of the UK pays more simply because he lives on the “wrong” side of the “border” or that he has less access to certain drugs than other citizens who are paying exactly the same amount of tax and social benefit charges to exactly the same central exchequer.

kensei said...

France is a bigger nation population-wise and has at least as many diverse regions as the Uk. It manages quite well on one health service,regularly voted the best in the world and we even ship some of our patients out there.

This is a non sequitur. France could very well have a better system with a more devolved setup, and just because something works for France does not necessarily mean it would work for the UK. French style Social Democracy has never went down well in the UK.

Moreover, the democratic deficit remains.

It does have a health-board system similar to the UK and if, for example, there are is a higher level of cancer found within a certain region, then resources are directed towards that area. That may well be regionalism, but it is logical and ethical regionalism.

What if diverting the cash to that region causes cancer rates to rise in others. This is the problem with planned systems: it is easy to fix one shortage, but it may well cause another.

The regional “variation” in the UK however occurs largely on cost to patient (ie prescription charges) and availability of drugs. It is immoral that a sick person in one part of the UK pays more simply because he lives on the “wrong” side of the “border” or that he has less access to certain drugs than other citizens who are paying exactly the same amount of tax and social benefit charges to exactly the same central exchequer.

No, it is entirely ethical and democratic. Each region gets resources on an agreed formula, and then chooses how to spend it. If it is spent on health, it is not spent elsewhere. It is unfortunate, but not the Scots fault if England doesn't want to pay for the drugs. If the English are angry, they have a simple solution: vote for a party taht will pay for the drugs.

O'Neill said...

This is a non sequitur.

I was showing that a larger country with as many regional variations as the UK provides a better health service than our devolved one. I’m not saying obviously that centralization is the only reason for that, only showing it doesn’t preclude an efficient health system.

Moreover, the democratic deficit remains.

Everyone pays exactly the same amount of tax and expects to receive the same level of service at the same price in France, what could be more democratic than that?

What if diverting the cash to that region causes cancer rates to rise in others. This is the problem with planned systems: it is easy to fix one shortage, but it may well cause another.

Every health system needs planning. How efficient that planning is depends on the planning system, not the system of government.

No, it is entirely ethical and democratic.

Whilst there remains a UK and a uniform income tax system, then everyone should be entitled to exactly the same level of health services.

If the English had been given a chance to vote on whether or not devolution was granted for Scotland, Wales and N.ireland, then they could not now argue at how the devolved health system has left them at a disadvantage. But they weren’t and since all three countries are run at a loss (and England at a profit) it is their taxes which are effectively paying for a system which discriminates against themselves.

If the English are angry, they have a simple solution: vote for a party taht will pay for the drugs.

If they complain enough about this devolution of health, do you think their MPs will listen and reverse it after the next election?

O'Neill said...
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