That a Labour MP wants to nationalise more of the British health care system shouldn’t come as a surprise. All within the state, nothing outside it, the impetus for the National Health Service is indeed Mussolini’s fascism brought to post-war life again. And we should let him do this too. As long as we force him to stick to one of the promises he’s making:
But it isn’t perfect. As data published this week shows, patient demand for general practice services is increasing while the number of GPs is actually falling – according to the survey, one in 10 GPs are in contact with 60 or more patients a day, which is double the safe limit. At a time when people are living longer, and health problems are becoming more complex, the government has spectacularly failed to deliver its promise of an extra 5,000 GPs. Not enough medics want to be GPs, and too many doctors leave general practice too early.
Well, this is a result of government planning of course. GPs are now, at the entry level at least, a female led profession. And government controls the number of places available to train as a GP. The government neatly managing to miss that you need more females than males to provide the same level of cover. For it’s not exactly unknown for women to desire to take time out to have their children, move part time in order to raise them. And on a GP likely income – £100k and up – there are many women who will indeed swallow that £250k of taxpayer investment in their training then live on £50k a year for a decade while they raise the anklebiters.
It’s possible to muse on forcing people to repay their training costs if they do go part time but much more important is that very justification for the government run health care service in the first place. That only government can properly plan such a thing. Which isn’t obviously so now, is it?
But anyway, to the actual proposal:
Employee-led mutuals should be created within the NHS with nurses, doctors, pharmacists, therapists, managers and patients all having a say in how the organisation is run. These new organisations – instilled with a progressive and innovative culture – would be much better working environments for staff, with improved career pathways for nurses and more incentives to invest in people. As they would be within the NHS, there would be no profit motive. Crucially, they wouldn’t be able to pick and choose which services to offer to their patients. Struggling practices could receive investment to bring them up to the level of the best. This model would enable a strategic shift from reactive and hospital-based care to preventive community care – without the NHS having to pay a premium price that includes GP profit. All existing GPs should be offered salaried employment within these organisations. Those that wish to retain their existing contractual arrangements should be allowed to do so. This is likely to be particularly important in rural communities.
It’s that last which is important. We would then have the one part of the health care system that had both models. There would be profit driven, shareholder interested – for that’s what partners are in a practice – GP services and there would be state salary and mutually owned GP practices under that tight NHS control. A decade down the line we’d be able to observe who was doing better at what cost.
Actually, we around here don’t just think why the hell not try this out but Hell Yes, Let’s Do This! Because we’re absolutely certain that we’re going to gain a much better result from those profit driven mavens. And the public obviousness of that will mean that we’ll then convert that monolithic, Stalinist even, NHS to the system that actually works. One of competition and markets, even if all is still taxpayer financed.
So, bring it on, let the experiment commence!