June 20, 2007

It's. Too. Big.

This time it is the Conservatives stealing an Labour policy. It won't work for them either. Patricia Hewitt is right on this one, the NHS is simply too big to be manageable. Handing it over to an independent board (and how independent they will be in practice is still anybody's guess) will not change that. The inertia of the huge bureaucracy of the NHS will still resist all attempts at change while sponging up any extra cash that becomes available so it never reaches the clinical professionals.

There are economies of scale, but there are also diseconomies of scale as the hierarchies of bureaucracy grow, and so efficiency against size forms a curve[2]. This happens in all organisations whether public or private. Any organisation as big as the NHS would be inefficient and there is absolutely nothing going to change that unless they also do something about dividing it up into more manageable sized chunks. Maybe still as a state run system, but run by local government as in Sweden. Perhaps a multi-payer/multi-provider system as in France[4] where the hospitals are all independent organisations and the state just provides a basic universal insurance. Or if you want to be radical get the state out entirely and just have it recognise that because some things are important they should not be taxed as in the Singapore system for healthcare. It is the NHS's obesity that is killing it. The crisises might individually be dealt with, but unless the root cause is too then they will just come back.


Blogger youdontknowme said...

I think the NHS is fixable but I don't believe the government is competant enough to fix it.

I would have it run by a Health Assembly made up of elected Health commissioners elected on a county basis. These commssioners would have to have been working for 5 years as a medical profession before they could stand for the health assembly.

Individual health commissioners would be responsible for healthcare in their area as well as the pay for the employees (I think its daft that NHS employees in london get the same as everywhere else).

At national level they would be responsible for things like training, NHS tax (they need to fund it somehow) and they would be responsible for licensing drugs (taking the place of NICE) and setting down criteria for how drugs should be tested by the pharmaceutical companies which will hopefully bring down the cost of drugs.

4:56 pm  
Blogger chris said...

That could work, and sounds a bit like a more complicated version of the Swedish system where health care is provided by local rather than national government. This would reduce it's scale and therefore at least offer the chance of it getting better. My personal preferred scheme is the French multi-payer/multi-provider system since it removes even more of the bureaucracy by devolving the decisions to the individual hospitals and patients.

5:08 pm  

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