Henry Featherstone

Quite why people are surprised that Andrew Lansley has stuck to his plans to introduce GP Commissioning is a mystery.  I’m struggling to recall one of his speeches or policy documents in recent years where it wasn’t mentioned. Anyway, let’s be clear, widespread control of commissioning budgets by GPs was where the NHS was headed until Frank Dobson took over in 1997 and unravelled a decade’s worth of market based reforms.  Rebuilding that position has taken another decade of circular re-organisations to fix.  No wonder the NHS is ambivalent about reorganisation.   These proposals are, of course, radical.  But they are needed to address the fundamental flaws in the NHS commissioning landscape.

So, NICE, the body charged with ensuring cost-effectiveness in the NHS, says that alcohol minimum unit pricing is the most effective way to tackle excessive drinking and its impact on the NHS and society.  Interesting, and certainly a challenge to the new Health Secretary and his alcohol taxation review, but ultimately misguided.     Where NICE have got it right, is that there is a clear and consistent relationship between the price of alcohol and its level of consumption.  Indeed, the effects of price changes on alcohol consumption are more effective than other alcohol policy interventions, such as restricting the number of outlets, or bans on advertising or price promotion.

Every few years we unearth another hospital scandal in which we discover, all too late, that many patients have needlessly died.  On the face of it there is no common theme to these failures: the bug clostridium dificille at Stoke Mandeville, possibly similar infections at Maidstone & Tunbridge Wells; emergency admissions at Mid-Staffordshire, and possibly poor hygiene at Basildon & Thurrock. But, as The Sun points out today, it seems that the Department of Health was warned in the strongest terms about flaws in the healthcare oversight mechanism. It is astounding that there is no system of performance improvement in the NHS.  But suppose there was.

A common response to the impending age of austerity in the NHS is to suggest that charges are introduced for visits to the GP.  The line of reasoning adopted by MEPs and think-tanks alike is that a means-tested £20 charge will "encourage healthy, wealthier people to use the NHS only when absolutely necessary." Leaving aside the fact that such a system would cost more to administer than it would generate in revenue, a more interesting question is whether the converse holds true?  That is, whether unhealthy and poor people aren't using GP services when they should be.  The consequence of this is more profound because poor and unhealthy people tend to cost the NHS much more than few unnecessary appointments booked by the worried well.

In an email this morning, David Cameron told me (and thousands of others registered for the Conservative conference) that he is proud of the NHS.  Me too.  Call it Orwellian if you like, but equitable access to healthcare is a pretty good thing. But who has the best healthcare system, the USA or the UK?  Answer - neither.  While total spending on health is very different - 9% of GDP in the UK and 17% in the USA - the extent to which both healthcare systems save lives show the USA as the worst in the developed world and the UK not far behind.  France, Japan and Australia are the best.