Ducking the issue?

As I wrote earlier, a large proportion of Andrew Lansley’s white paper had to be devoted to accountability. Much of it is, but little is explained. Patients are central. The creation of GP consortia is for their benefit and they will hold the consortia to account by excercising choice (4:21). Choice is the tyrannical panacea that does not exist. A patient can only improve a treatment if they are given it; and many GPs are closer to Doctor In the House rather than Dr.House. GPs are independent practitioners working within the NHS framework. For example, it is impossible for the patient to make recommendations about unavailable cancer drugs.

In addition to the patient, the NHS Commissioning Board will regulate the consortia. According to a turgid paragraph on page 35 of the white paper, the Commissioning Board will allocate resources, manage a revenue limit and promote productivity. There is no mention of overseeing or scrutinising consortia managing budgets wortha total of £80bn.

Presumably Lansley intends that Monitor, the health Quango, will perform that function. But I can see nothing in its rudimentary remit that suggests it will do so. Sections 4.28 – 4.29 define Monitor’s duties. It will investigate complaints of anti-competition purchasing, regulate prices and license providers.

Lansley’s emphasis on competition is pervasive, and this enforces the impression that his reforms are of the stunted market variety. In truth, there is no competition because there is no choice. If you have independent practitioners, and you believe that competition would improve the quality of care, why not free doctors from institutional rigidity? These reforms amount to a gargantuan top-down personnel re-structuring, with the added problem that £80bn will remain largely unaccounted.