The Liberal Democrat plans for the NHS

A few days ago Liberal Democrat spokesman Norman Lamb  (aka the man who beat Iain Dale by 10,606 votes in 2005) kindly gave up some time to be interviewed about the party’s plans for the NHS.

Having previously pointed out that the party’s “four steps to a fairer Britain” doesn’t include how we will improve public services, I started by asking him how the Liberal Democrats would improve the NHS.

He explained that whilst the four steps are a plan to transform Britain, for the NHS the priority over the next few years would be “making sure it doesn’t get destroyed” given the tough spending choices that would have to be made to cut the deficit.

However, he believes the NHS can be protected and even improved despite an end to the era of large regular increases in its funding. To that end, he outlined four steps for the NHS:

1.       “Ensure value for money and reinvest savings in the NHS” – an important difference from other areas where savings will be used to fund new policy priorities (such as the pupil premium) or deficit reduction. For the NHS, “all savings achieved in health will be reinvested in health” and there would be a switch from paying for activity to paying for levels of patient care, thereby encouraging preventive health work.

2.       “We must dismantle the central bureaucracy” and instead “give people a say via elected health boards”. The Department of Health would be trimmed, Strategic Health Authorities axed and regulation rationalised. At the moment, 60 different organisations regulate or inspect hospitals in one way or another – at huge financial and staff costs and with the result that hospitals end up employing people who just deal with the regulation and inspections, so cutting them off from the actual coal face.

3.       “Guarantee operating times – or pay for people to go private instead” – the important point being a service free to the patient, rather than who the provider of the service is. Although Norman pointed to Denmark as an example of this policy working well in practice, it also has (unintentional) echoes of policies pursued by several Liberal Democrat councils. Islington, for example, introduced a policy of paying for private contractors to repair properties if the council missed its repair deadlines.

The benefits of the policy would not just be better immediate service for patients but also a subtle shift in the dynamics of how the health service is run. Currently budgetary pressures lead to services being provided less well; however, under this new scheme the way to save money would be to make services better – so that you do not have to pay for the person to use a private provider.

4.       “Give the million unpaid carers who work the longest hours get a week’s break every year – to be taken in whichever way they choose”. I queried why this specific pledge – of all the many that could be made – was in the four steps. Norman Lamb explained that this was because it is the party’s alternative to Labour’s Personal Care at Home Bill, which has been heavily criticised for failing to deliver help to those most in need. With Labour making that Bill central to their health campaigning, our alternative should be central to ours.

Turing to one of the big causes of wasted money in the NHS – IT – Norman Lamb described the NHS IT program as “a complete disaster … imposed from on high”. He was particularly critical of the way in which the scheme had not been properly scoped and was based around replacing existing systems with one new central system.

Instead, Norman Lamb argued, the NHS should be laying down standards which different systems could then meet and use to work together. This diversity of supply would build better on existing working systems and provide the necessary competition and innovation to keep future systems value for money and effective. A good health service, Norman Lamb said, required good IT.

On the question of personal records – just being introduced in England and central to many of the NHS IT plans – although Norman said he personally probably would not opt out, he had many sympathies with those worried about the security of the system: “a database can’t be 100% secure”.

He highlighted, in particular, one way that the theoretical security would fall down in practice: busy GPs leaving their security cards in the card readers so that others can pop in and out of the system as needed during the day.

Ending by comparing the Liberal Democrat plans for local health boards and devolved accountability with the Conservative Party’s plans, Norman Lamb was scathing about the Tory plan for a “completely unelected quango in charge of a £110 billion budget”, i.e. their ‘independent board’ for the NHS.

In contrast, the Liberal Democrat plans would mean people could genuinely hold the local health boards to account – both because of the elections to them and because those health boards would have the power and the budgets to make their own decisions. If they’re making their own decisions (rather than following orders from on high), then they can be held truly accountable for local health services.

UPDATE: Looking back on this interview, it’s notable now how little mental health featured – something which became perhaps Norman Lamb’s predominant contribution to British politics subsequently.