The middle way

First published 31 Aug 2011

The latest controversy surrounding the Coalition’s health and social care bill stems from the legal advice obtained by the campaign group, 38 degrees, that the revisions allow the health secretary to wash his hands of the duty to provide a national health service.

This report has brought the expected response from many quarters, demanding that the health secretary retains full controlling influence over the NHS.  But for many years, when senior health leaders have been asked to cast their vote for the single most important change required for the NHS, the overwhelming demand has been to remove the whimsical hand of politicians from the tiller.  So clear has been this demand, that in 2007, the Nuffield Trust published a thought piece exploring various models which would indeed sever direct political influence.

This is just the latest example of the complete polarisation of debate whenever the NHS is discussed.  We seem destined to end up at loggerheads between the two ideological extremes of “preserve the NHS ownership in public hands at all costs”, and “the NHS needs to be subject to market forces before it will get the best from efficiency, innovation and quality”.

Where and how is the middle ground to be found?  Certainly not in the ill-informed rhetoric and the knee-jerk reactions which dominate.  As we have argued elsewhere, the NHS provides only a small fraction of the overall care, and much of that is already in the private hands of small businesses.

What we need is an enlarged vision of a care ecosystem, in which the existing diversity of contributions from all manner of providers is properly recognised, whether they go under the name of social services, NHS, volunteer carers, social enterprises, or private for-profit companies.  The most compelling and urgent case for reform, is that we stop the partisan fighting over organisational form, and start concentrating on setting out precisely how “free at the point of need” translates into a nationally consistent and coherent entitlement, delivered in a locally relevant context.  The only question relevant to the Health Minister is What?, not How? or When? or Which? or Who?  I could perhaps sit on the fence when it comes to Why?