You\’re absolutely correct here:
Let\’s get one thing straight. The NHS does need constant reform – always has and always will. Megalomaniac politicians of all parties love mighty structural upheaval, but what works is detailed, expert and quite dull. Health economist Prof Alan Maynard, observer of many pointless upheavals, has made the case for evidence-driven medicine for decades. Money is saved and health improved by obliging all to follow best treatment guidelines. The Isle of White saved A&E admissions by sending nurses to teach asthmatics to use their inhalers correctly, so why not everywhere? Nurses can do 70% of what GPs can do, cheaper and, he says, often better because they do follow guidelines. And why have GPs just escaped scrutiny of their performance, by refusing to hand over their data? Prof Ara Darzi\’s research shows re-admissions after bowel cancer operations vary wildly: heart treatment was improved by eliminating the worst practice outliers. Nursing patients kindly sends approval rates soaring.
Forcing all the NHS to follow Nice guidelines doesn\’t need markets or politically inspired reorganisations. Money coupled with tough targets worked well for Labour, though it too squandered much on vainglorious \”new\” systems. Let\’s hope the Lords arrest the damage done by this one.
It really is all about how to get the system into that state where it is constantly striving to improve. How to get that detailed, expert and quite dull constant and consistent improvement in treatments as we gain new knowledge about what can be done and about how what we want to do can be done best.
We have essentially two systems which we can use to do this. We can have armies of bureaucrats with targets and clipboards insisting that everyone do it the way they think or have been told is best.
We can have autonomous organisations competing with others in a marketplace.
That\’s perhaps a rather stark and over-rigid description but it is the essential underlying truth. What is the best way of spreading best practice?
The 20th century ran this very experiment on a grand scale in a number of different places. East v. West Germany, the Soviet Union against the US, North v. South Korea. Very simple empirical observation would lead us to the conclusion that the market based approach wins in this competition.
We can even detail the mechanism by which this happens: resources are always constrained so what we need to look for is an increase in total factor productivity. Getting more from those resources that we have available to devote to a particular task.
It is said that the Soviet Union, in its entire existence, managed to not increase TFP by one single iota. All the growth they did have came from an increase in resource use. Whereas 80% of the growth in the \”western\” economies in the 20th century came from TFP improvements. Only 20% came from increased resource use. I could even point you to the Nobel Laureates who make this point.
It isn\’t actually necessary for us to peer any further into the black box. Commissars and tick boxes are outperformed by market mechanisms.
Therefore let us have market mechanisms in our health care system.