Magazine article The Spectator

Fraud Is Less Harmful Than Coercion or Threats

Magazine article The Spectator

Fraud Is Less Harmful Than Coercion or Threats

Article excerpt

No major reform becomes irreversible until its principles are accepted by both the main political parties. Thus it was with the Attlee government's health service reforms and with Mrs Thatcher's trade union legislation; thus it now is with the last government's health service reorganisation, as a result of Frank Dobson's latest proposals.

In one respect, the new White Paper is a considerable achievement on Mr Dobson's part. He has managed to persuade his officials to write down to his level. Rarely, if ever, has a government document been so full of twaddle - 'the new NHS' - and gimmicks - 'The new NHS Information Superhighway'. Then again, rarely has a government document been so unnecessary. Its sole purpose is to assist Mr Dobson in concealing from his Parliamentary colleagues the extent to which he has now accepted the Tory changes which he and they used to denounce so wholeheartedly.

The basis of the Tory reforms was to insist that the NHS could only work effectively if there was a clear distinction between those who provide medical care and those who purchase it, so that market mechanisms could be used in health as they are in other areas, to ensure the efficient use of resources. Underneath all the bluster, Mr Dobson has accepted this.

Which is not to say that his reforms are harmless. On the contrary: they will impose unnecessary administrative burdens, and therefore costs, on the NHS. When it is not necessary to change, it is necessary not to change, and that applies a fortiori to recent reforms which are still settling down. Many doctors have only just got used to GP fundholding. They will now have to come to terms with Mr Dobson's new variant of GP fundholding. This will require hours of paperwork: time and energy which could be better spent.

There is another dangerous aspect of Mr Dobson's reforms; a know-nothing disdain for the work of health service officials and an assumption that most of the money spent on administration, accountancy et aL is wasted. Now it may be that the Tories' reforms were too bureaucrat-friendly; that is the case with most reforms which are implemented in detail by the civil service. It may be that it would have been better to privatise much of the administration of the health service. But there must be administration; an organisation as big as the NHS cannot function without a central nervous system. That was the problem before 1979, when the health service was largely an accountant-free zone, and therefore resembled an especially primitive species of dinosaur; its backside could be on fire for quarter of an hour before the smoke reached its nostrils. In those days, one health authority would spend x on treating an ailment and its neighbour 4x without any discernible difference in patient welfare. Without accountancy - and internal markets - those days would return.

But all in all, Mr Dobson has done as little harm as could be expected of him. His White Paper may be fraudulent, but fraud is better than coercion, which brings us to Dr Jack Cunningham. The Agriculture Minister's decision to ban beef on the bone was not the worst abuse of government power this century: that bad eminence is occupied by the Cleveland social workers of the mid-Eighties who, afflicted by collective hysteria, confiscated a large number of children from their parents. But Dr Cunningham's decision was as unjustified as it was cynical. The only rational explanation for the ban was a desire to re-ignite public hostility to the Tories over their handling of last year's BSE crisis; like most of his Cabinet colleagues, Dr Cunningham is still determined to win the last election. …

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