Every few weeks someone pops up and says that politics – and politicians – need to be taken out of the NHS. The person proposing this change usually argues one or two things: first, that the NHS has become ‘a political football’, and being subject to the whims of politicians with their ‘top down reforms’ is damaging it. Second, they may also argue that politicians know nothing about delivering healthcare, and we should instead put doctors in charge – because of course doctor knows best.
I notice this argument every time it is made because it makes me grown out loud. It is now time for me to explain exactly why this is a terrible idea:
1) Doctors make good doctors – but healthcare management is something else
Doctors know an awful lot about looking after patients and what good care looks like, and so their voices must be a significant part of strategic and operational management in the NHS. But the fact remains that managing budgets of half a billion and more, and managing a workforce of more than ten thousand people takes a whole different skillset – and many NHS Trusts in England have even larger budgets and workforces. Granted, management in the NHS at present falls short – as I have argued time and again – but it is clear that asking doctors to do the job of chief executives is ridiculous in such a large, unwieldy organisation.
2) The NHS budget is enormous
If the NHS was spun out into an independent statutory body it would continue to rely on the Treasury for its budget, and would likely call for more money with no regard for how it would be raised. We currently spend more than £100 billion a year on the NHS in England alone. Representatives of the doctors some people want to run the NHS for us consistently call for increased budgets – including more pay for doctors themselves. The government would either have to roll over and hand the NHS extra cash with no ability to ensure it is spent sensibly, or deny requests for more money and continue to be painted as the bad guy.
3) Accountability is crucial
It is my view that one of the key reasons the NHS continues to underperform is that its customers – that is to say the public – are very limited in how they can hold it to account for their care. Patients have little say over the type of care they get and how they receive it, it’s very difficult to get change through complaints, and unless you have plenty of money you have no choice but to use the NHS.
There are two ways in which people can hold organisations to account for their services: through the market, by choosing another organisation or service when the one they are using does badly or simply doesn’t suit their needs; or through democratic means, by voting out governments that don’t manage services well.
With trust in politicians so low, it is tempting to think that taking politics out of the NHS would solve all of our problems – but it would actually create many more. Any service used by the public and paid for by the taxpayer is inherently political. And so the only way to take politics out of healthcare is to take the government – and our taxes – out of it too.
An independent NHS would not only be independent from politicians, but independent from the public too – and that would only worsen the current problem of ‘like it or lump it’ healthcare.