Saturday, April 02, 2011

A Tale of Two Reforms

If you want to know whether Andrew Lansley's proposed NHS reforms are a good idea you need only take a look at the Conservative Home poll on the subject. When 84% of that site's readers agree that the reforms are necessary, you know there's a problem. Conservative Home and the Daily Telegraph compete for the readership of the core, right-wing base of the Tory Party - the same base that thought Hague, Duncan Smith and Howard were good leaders, but have real reservations over Cameron. And if they like an idea, you can bet it's probably going to go pear-shaped.

One of the key Tory perception problems - correctly identified by the Cameron team - is that they genuinely dislike public services, especially the NHS, and would like to cut them down. Margaret Thatcher, despite regularly increasing the sum given to the NHS, never quite managed to banish the impression that she'd rather privatise the whole thing. Thatcherite Tories want the NHS to be "good value for money". Well, don't we all. But many Tories think that the provision of health care can be neatly quantified, and that the only people who can do this effectively are the medically trained doctors in GP surgeries rather than the financially trained managers trying to organise the various healthcare trusts. Most Tories use private healthcare provision anyway - the sort that's properly run by business and finance aware managers whose work lets the doctors get on with their primary job of actually healing - and aren't overly bothered by the impact of reforms on the NHS. There is, I think, a sneaking suspicion that most people who use the NHS don't really need to - they're just being hypochondriacs, a bit like all the welfare cheats.

Lansley's reforms, with their odd emphasis on the wrong people managing the business side of healthcare when they should be managing the medical side of healthcare, look increasingly like a car-crash bearing down on the Coalition. Even the Conservative Homers, in their slavering desire to decapitate the NHS, also recognise that if the reforms go wrong it would be a disaster - 72% of the cuddly Conservatives apparently believe it will be hard for David Cameron to be re-elected if the reforms go wrong. Lansley's background as policy wonk and politician may not have been terribly helpful in assessing the practical problems of what he is proposing.

All of which seems to be in contrast to the under-stated but efficient way in which welfare minister Chris Grayling is now planning to radicalise the apparently often abused Incapacity Benefit. The Spectator's Fraser Nelson, one of the bash the Coalition crowd, is impressed by the way in which Grayling has gone about his task, which could substantially alter the level of Incapacity Benefits issued and increase the progress of the welfare to work reforms. Of course, Grayling benefits from the fact that welfare reform is often so complex and humdrum that no-one can be bothered to check the details, and in any case only affects a minority of the population (although 2.6 million people, the number currently on IB, is no mean minority!). The NHS potentially affects us all. But perhaps a little closer attention to detail, and the realisation that pleasing the Tory base is often a sure fire way to alienate what we might call the broader electoral base, wouldn't have gone amiss when Mr. Lansley was dotting the i's of his current grand reforms.

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