THERE was a revealing moment on the BBC News at Ten a couple of nights ago. At the royal College of Nursing conference in Liverpool a delegate announced that she was not against change.
But, she added, as she raised her fist for emphasis, change was only good if it benefited nurses. There it is in a nutshell.
According to her the purpose of the NHS is not to make people better, rather its main mission is to be an agreeable place for staff to work.
Despite scandals such as Stafford hospital, where more than 1,200 patients suffered avoidable deaths largely because of staff incompetence and sheer sloppiness, the RCN still seems to think its real name is actually the royal College of Angels.
The British Medical Association, the doctors’ trade union, also enjoys posing as the true champion of patient care. But its greedy decision to push for a contract giving the average GP a salary of £110,000 without any night or weekend working was responsible for a huge drain on NHS resources and a major knock to productivity.
In their opposition to health Secretary Andrew Lansley’s health and Social Care Bill both the RCN and the BMA are doing what any trade union would do. They are pushing against change. Change in any workplace is difficult and sometimes there are employees who lose out.
But change is hugely necessary for the NhS. We are living longer, demanding novel and expensive treatments and more of us have chronic conditions such as obesity or diabetes. We’re used to choice these days and expect more.
Fewer of us want a takeitorleave NHS where decisions are made by a remote primary care trust rather than GPs, whom we trust and who may well have known us for decades. Power and accountability should be devolved down as close to the patient as possible.
That is precisely what Mr Lansley’s plans mean. Where they have been trialled so far they have proved to be a huge success. Many family doctors have leapt at the chance to seize control of how, where and when their patients should be treated. They will be able to try new ways of looking after patients, such as remotemonitoring or “telehealth” in which, for example, there is huge potential to improve diabetes care.
Getting rid of primary care trusts will also eliminate huge bureaucracies run by chief executives who are often vastly overpaid. All the money saved will be available to spend on the everincreasing demand for NHS services. Not a penny is being taken from the NHS budget, thanks to David Cameron’s decision to ringfence it.
My organisation Policy Exchange has reservations over the timing of the changes. We think 2013 is too soon for them all to be completed. But the fact is that the NHS has not changed in any significant way since its creation in the Forties.
It is not good enough to say that the NHS is perfect and all it needs is a continual supply of more and more money. The evidence shows that when the funding taps were turned on by Gordon Brown after 2001 it led to diminishing returns. For every extra pound taxpayers put in, patients got less and less back. Cancer, stroke and heart treatment survival rates are still below those of other wealthy countries.
Although we are justifiably proud of the NHS – and at its best it truly is world class – the fact is no other country has imitated the giant, centralised bureaucracy that we created almost 70 years ago. But all this just washes over the RCN and BMA.
They know that the NHS is our modern day equivalent of the Church of England or even the monarchy - one of the things that bind us together and which nearly every one agrees is a “good thing”.
No matter how many reports reveal that care of the elderly in hospital is a national disgrace or that Labour’s spectacularly mishandled Private Finance Initiative meant new hospitals will end up costing six times their actual price, the unions know that many members of the public will rally when they wave a shroud embroidered with the slogan: “NHS in peril.”
A similar process is going on with education. The coalition wants to hand power over schools to parents and local communities. But the teaching unions have launched a rearguard action against free schools and academies, smear ing supporters of reform. And what are their objections?
In truth they care more about the fact that free schools and academies can reward good teachers and sack bad ones. The prison officers’ union is now balloting for strike action, complaining that plans to make jails run more efficiently will leave their members worse off. But in whose interests should prisons be run? Surely in the interests of victims of crime and of potential victims.
Economists have a term for this: they call it “producer interest”. Labour never stood a chance of properly reforming services thanks to being in the pocket of the public sector unions that financed them. With the coalition we do have a chance but, if ministers go floppy and feel that because they are sticking up for people who actually use the services they have to keep saying sorry to trade union activists, that chance will evaporate.
Mr Lansley must stop apologising and stick with the course he has set out. The same goes for other ministers. Voters will no longer forgive any politician who puts the interest of the producers ahead of the sick, the young and the vulnerable.