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Taxpayers' generosity towards the NHS is not always good news

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Politicians and health professionals across the spectrum seem to have a variety ideas of how best to prepare the 21st century NHS financially, but we’ll need to harness the power of commissioners to cover the myriad individual and community health choices


So another opinion poll suggests most voters are happy to pay more taxes to protect current levels of NHS care and services; 57 per cent against 41 per cent who would be unhappy, according to this week’s ComRes/Independent poll.

‘A poll suggests most voters are happy to pay more taxes to protect current levels of NHS services but is this good news?’

Is that good news for the chorus of health professions and trade unions, even politicians, calling for more health spending?

Not necessarily, for several reasons.

Justify the spend

Voters calling for higher taxes rarely expect to pay much more themselves.

In any case, though Labour’s policy review process is said to be examining options for a fresh “health tax” - another 1 per cent on national insurance anyone? - shadow health secretary Andy Burnham sounds as wary as former health secretary Alan Milburn does in the present climate.

In a recent interview with Total Politics magazine, Burnham said: “Before the NHS asks for more money, it’s got to be able to look people in the eye and say ‘we’re spending every penny you give us as best as we possibly can’. It genuinely can’t do that today.”

Steady on, Burnham. Didn’t Stephen Dorrell and Sarah Wollaston – his newly minted successor as Commons health committee chair – plus Lib Dem ex-health minister Paul Burstow all tell The Observer the service needs more money to avoid a pile up?

Doesn’t Dorrell say it’s inevitable - has been “for 5,000 years” - even now the economy is growing again, it’s only right it should get more. “Unthinkable” not to.

‘Dysfunctional and inefficient’

Indeed, and The Observer claims that health secretary Jeremy Hunt has been bunging bags of the green folding stuff at NHS crisis points more quietly than he’d like to because Number 10’s spin doctor Lynton Crosby has told the prime minister that a high election profile for the NHS can only benefit Labour.

I’m not sure that squares with Hunt’s noisy drum beat for greater patient focused openness, but never mind.

‘The system is dysfunctional and inefficient, says Dorrell’

The awkward fact is Dorrell’s speech to the pro-market Reform think tank this week argues that funding – let alone the UK’s “free” taxpayer model of funding – is a distraction from the core challenge.

He means a radical reform of commissioning to address health in a holistic sense, rather than what the NHS had traditionally done: GP or hospital care, drugs and such.

The system is dysfunctional and inefficient; “it delivers bad care,” he said.

21st century care

The 21st century NHS must harness the collective power of commissioners to the myriad individual and community health choices we all make, on social care for mum as well as health.

It must emerge via a new partnership which embraces changing technology, organisational and social behaviour; all unsettling to health status quos everywhere, Dorrell says.

If it sounds close to Burnham’s “whole person” approach to integrated care, that’s because it is. But don’t throw your stethoscope in the air yet.

‘We can see the outlines of an integrated, outcomes focused consensus, but not on how to get there’

We can see the outlines of an integrated, outcomes focused consensus, but not on how to get there. Burnham has thought hard about his ministerial past and decided Labour went too far towards market solutions; Lansley’s law went much too far towards cherry picking fragmentation – he has pledged to repeal it.

Dorrell barely bothers with what he probably regards as a sterile distinction in 2014.

Implicit in his speech was what New Labour’s Paul Corrigan and Care UK’s Mike Parish spelled out in their Going with Change report – the one attacked by Observer pundit Will Hutton.

That would deploy market power against the innovation resistant NHS to force it to do what supermarkets and car makers did to adapt, survive and thrive in our online, tech driven world.

Scary? Yes. But the poll also found that 67 per cent of voters don’t mind if private firms deliver NHS services, provided they remain free at the point of use. Bear that in mind too.

Michael White writes about politics for The Guardian

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