Monday, April 4, 2011

Never mind the quality, feeeel the cheapness.

One of the basic fundaments of UK politics is that parties don’t expect us to take anything contained or promised in their manifestos too literally but still, this proclamation from "Lynn of Co Antrim" does fall down on two crucial points:
“My DUP has delivered free prescriptions for everyone in Northern Ireland, the most generous scheme in the UK”
First, whose idea was the free prescription”?
Under the aegis of whose “ministry” was it introduced?

Secondly, both Wales since 2007 and Scotland (admittedly the day after Lyn of Antrim made her claim) since this year have also offered free prescriptions, so it’s not strictly accurate to call it the "most generous” scheme in the UK.

Incidently, I hope Lynn does indeed come from Antrim and not somewhere like Little Muck, Arizona....  the DUP did have one or two problems on that score before.

But as I said, no one reads manifestos, never mind believes the nonsense inside them. More important is how, as touched on by Owen Polley here, we look to improve upon the delivery of our health service and (management, trade-unionists and bureaucrats hold your breath now) ultimately “empower” patients and doctors (ie provide better healthcare, more efficiently)

In England, as the CEP have been quick to remind us this week, prescriptions have gone up from 7.20 pounds a week to 7.40.

On bare facts, devolution has, once again, delivered an unfair state of affairs.

However, despite those discrepancies in prescription prices:
Historically Scotland, Wales and Northern Ireland have had higher levels of NHS funding per capita thanEngland. The research confirms this but shows other striking and troubling differences between the four nations, some accentuated since devolution.

In particular, these were higher numbers of doctors, nurses and managers per head of population, lower crude productivity per staff member (particularly in Scotland), and a higher percentage of the population waiting for care in Wales and Northern Ireland than in England.

The analysis presented in this report suggests that England’s NHS spends less and has fewer staff per capita than the health services in the devolved countries, but that it makes better use of its resources with respect to delivering higher levels of activity and productivity and lower waiting times. Comparing the devolved nations with regions of England that are similar on a range of health and socio-economic indicators, the differences highlighted in the analysis are even more pronounced.
I posted that finding from the Nuttfield Trust just over a month ago.

So, English patients do pay prescription fees but also receive a better quality service than that “enjoyed” (or make that “endured”) by their fellow Brits in Scotland, Wales and Northern Ireland. Why?

Well, in my opinion, prescription prices, like University Tuition fees, have become the Devocracy’s populist rallying call in the hope that the short-term dust the debate throws up blinds the electorate to the fact that in both areas nasty truths have only been temporarily postponed.

Actually, it’s only one nasty core truth- society is not prepared to pay the extra money needed, or make the sacrifices required (eg unemployment resulting from streamlining the NHS or less students attending university) to deliver the kind of high-quality health service or third level education system they demand.

The Devocrats in Northern Ireland, Scotland and Wales know that fact and as a consequence have taken the coward’s way out:
“You get a worse health service than the English and it’s getting worse but hey, we don’t charge you prescription charges"
“The quality delivered by our universities is going down the pan but sure, if we don’t charge you to attend them in the first place who cares?”
In the ideal world (ie around about one generation ago) we could get away with free (OK, that was always a misnomer because somewhere down the line someone did have to pay) university education and prescriptions. We’d all also be 100% happy with the service offered by the health service and third-level educational institutes.
But both demographically and economically, we most certainly don’t live in that ideal world.

 I don’t want to pay for my prescriptions and in the far-off future, I don’t want to have my offspring paying to attend university. But I also demand better than adequate healthcare and high-quality third-level education- how do the devocrats in Belfast, Cardiff and Edinburgh propose to square that circle?
Shush- I think I can just about hear the pitter-patter of a tactical retreat.


Kensei said...

The devolved regions are more rural, particularly Scotland so I'm unsure a straight comparison of numbers holds up. Secondly, England may well have adapted successfully for having less money for a long period: Id guess you can pull it back to pre fee abolition and see similar results. Thirdly, number of doctors isnt a direct translation to health outcomes.

I dont acty believe in completely free subscriptions. I can certain afford mine if needed, and some charge helps reduce waste. Means testing or free for some conditions would be sufficient. But it is certainly affordable - as is free university education. The idea that either would bankrupt the state is a flat lie. They do however impose other choices.

And that.s what devolution is for. If we want free prescriptions and less doctors its up to us. The idea that middle England should dictate is baffling.

O'Neill said...

The full report, in summary, said that health outcomes in the devolved regions, on a whole number of factors (not just doctor numbers) were worse than those existing in England.

On that basis, i think the populist "Free Prescriptions" and in the education are "Free Tuition Fees" is a smokescreen, a short-term populist measure that has become, unchallengeable and now written in stone.

It shouldn't be- it's depressing (with the half-hearted exception of the Scottish Tories) not one of the parties has stood up in NI, Scotland and Wales and been brave enough to say that prescription charges (or tuition fees) may be an alternative to release some funds to address those (increasing) discrepancies.

Kensei said...

Dont confuse the two policies. Prescriptions do not form a crippling cost for most people and are alreadt subsidised. There are some people with long term or very acute conditions who maybe have a better case, but in general most people can swallow it.

Tuition fees are an ideological move. This isnt additional money, it is simply replacing general taxation with more fees on students. Education is a public good and we all benefit from an educated workforce. Ive mellowed slightly on fees because some level of skin offers an incentive not to drop out. But up to 50,000 is an insane amount.

It is simply a lie to suggest it cant be afforded. It is an ideological choice to favour cuts here over those elsewhere, or higher taxation. But this is all beside the point. If the populaces of the devolved areas are more socially democratic than England, it unclear why exactly England should be dictating. What's your issue with democracy?

O'Neill said...

But this is all beside the point. If the populaces of the devolved areas are more socially democratic than England, it unclear why exactly England should be dictating. What's your issue with democracy?

I'm not saying England should be dictating in these 2 cases- but the discrepancy in health results between what is being achieved there and the 3 devolved parts should be closely examined. It's not in the interest for the devolved parties for that examination to take place hence the populist substitute of "free" prescriptions.

Interestingly enough, in Scotland it's the university management which is making the strongest case for tuition fees against the wishes of almost the entire political establishment. They are not doing because they want to deny anyone from third level education but because in the long-term, they don't see a viable alternative.