The NHS Debate on Radio 4

This morning Radio 4’s Week in Westminster ran a feature on the Coalition’s plans for the National Health Service.  The presenter Peter Riddell interviewed the Lords Fowler and Warner, Conservative and Labour respectively. These ‘veteran peers’ shared a good deal of ground in their discussion with Peter Riddell. Indeed an incautious listener might have come away with the impression that concerns about the Coalition’s plans for the health sector were overblown.

Fowler began by saying that, once you start looking to reform the NHS ‘everyone will oppose you at some stage’. Indeed you are going to hit ‘a brick wall of opposition’ particularly from the BMA. He cautioned that ‘the whole debate needs to be a bit more realistic’.

Having briefly noted that the public and the medical profession were too fond of acute hospitals, Lord Warner suggested that ‘a lot of the shroud-waving from the NHS about change is just that’. He went on complain that ‘the productivity of the NHS, given the money that Labour invested in it, has really been very disappointing indeed’. There had been, he said, a’60% increase in inputs 4% drop in outputs’. He went on to say that:

Any business that ran its affairs like that the shareholders would have thrown out the top management and probably they’d have been taken over as well.

One might have asked whether the government that oversaw this vast increase in expenditure should take any responsibility for the failure to increase productivity. The Labour government kept to the Conservative Party’s spending plans for two years after securing office in 1997. What were they doing in that time to determine how best to spend the new money? And did the sluggish productivity growth have anything to do with the government’s dogmatic enthusiasm for market mechanisms, management consultants, and the rest of the so-called reform agenda?

After all, the decline in outputs coincided with an increase in the use of the private sector.

Peter Riddell didn’t go down that road, though. Instead he fearlessly asked Lord Fowler how the government could break through the noise of political controversy with the ‘very rational arguments that you and Norman Warner have been putting forward’.

Lord Fowler began by pointing out that there were lots of ‘buzzwords’ out there, like privatization. He assured listeners that the government wasn’t going to privatize the health service:

I was accused of privatizing the health service, we didn’t privatize the health service, whatever that means …

He then repeated his point that ‘the whole debate has got to get a bit more realistic than it is at the moment’. And he again put the knife into the BMA. It and other professional groups, he said, were simply putting up a clamour.

So Fowler was twice able to call for a more ‘realistic’ debate and to dismiss the BMA for being shrill and self-interested. Talking points hit with considerable style by the old stager.

When Peter Riddell asked what changes Lansley should make to his proposals, Warner began by saying what he shouldn’t do:

The one thing he shouldn’t do is weaken the provisions on competition. The NHS needs an injection of new blood who bring innovation and new ways of doing business and the barriers to entry are still much too high.

He went to say that Lansley probably needed to keep ‘something like the Strategic Health Authorities’ to do ‘some of the grubby work of balancing the books’. Earlier this year Warner advocated ‘commissioning support hubs’. According to the Financial Times Lord Warner wants these hubs to employ ‘the best of former health authority and PCT staff and the private sector, to help provide [GPs] with the skills they need’.

In summing up Peter Riddell said that the two peers were ‘largely in agreement on both the need for change and for boldness in the face of vested interests’. Vested interests are, of course, the BMA, public sector unions, and so on. Not the private healthcare sector or their paid advisers.

Norman Fowler does not work for companies that would benefit directly from changes to the health sector. Norman Warner, on the other hand, is an adviser to Perot Systems Europe, a subsidiary of Dell with interests in the healthcare sector. He is also Executive Director of Sage Advice Ltd, a ‘private company engaged in advisory work, including public affairs advice.’

In other words, at a moment when there is intense public controversy about the government’s plans for the health service, the BBC thought it appropriate to invite a supporter of the Coalition and, for balance, someone who felt that it should be doing more to open up the NHS to the private sector. He is a paid adviser to at least one company that stands to benefit from the government’s plans.

As it happens Helen Boaden, the director of BBC news, gave a speech yesterday, which set out the importance of the Corporation’s complaints procedure.

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