Thoughts on politics and life from a liberal perspective

Sunday 16 August 2009

NHS debate - Daniel Hannan has not been clear enough

Well as usual when I go away for a few days there is a big story that I have come back to and have had to properly catch up with. This time it is the whole NHS debate kicked off by Obama's attempts to get healthcare reform proposals on the table in the US and brought into sharp focus in the UK by Daniel Hannan's disparaging comments about the NHS on Sean Hannity's show on Fox News (see below for embedded version) combined with the "#WeLoveTheNHS" Twitter campaign.

Allied to this and coincidentally, as part of my holiday reading I read "The Plan" by Douglas Carswell and Daniel Hannan, one chapter of which is devoted to the NHS and how it could be reformed so I have detailed insight into Mr Hannan's thoughts in this area.

As far as I can tell there has been much more heat than light in the "debate" on this so far. As Fraser Nelson points out on the Spectator blog today it has largely been mud slinging. It seems like the left is using this as an opportunity to bash the Tories supposed "real views" about the NHS, despite David Cameron's many on the record pledges to the contrary.

I have to say though, having this morning watched Daniel Hannan's appearance on Hannity's Fox News programme he largely has himself to blame. He spends much of the interview decrying the NHS and urging the US not to go down the "socialist" route that the UK has done. He also spends time pointing out (quite legitimately) some of the failings of the NHS. The problem is that at no point during the interview are any of the shortcomings of the US system even discussed. This is partly due to the ridiculous bias of Fox News in general and Hannity in particular who does not frame his questions like this or even play devil's advocate in order to test Hannan's views. But it is also Hannan's own fault for not taking the opportunity in an almost 7 minute interview to spell out what he thinks should happen.

Douglas Carswell has been complaining on his blog about how Hannan's views are not being represented correctly but he did not do so himself!

I will have a crack at briefly outlining the position described in "The Plan" which I presume is what Daniel Hannan thinks in detail is what should happen with the NHS. The chapter explains the shortcomings of the NHS but it also points out some of the failings of the US system, specifically that it is "burdened by too much litigation, regulation and producer capture. We can do better". It then goes on to describe how Singapore's health system works which revolves around a system of health savings accounts. Apparently they have better health outcomes than many European nations but it costs less than half (in GDP terms) what we pay in the UK. There is discussion of how this leads to Singaporeans generally making healthier life choices because it is ultimately their money they have saved that will be spent (or not and hence available for other things or once a threshold is reached no more payments needed). Also, catastrophic health care insurance is used to cover major problems that cannot be covered by the savings. There is then discussion of how a safety net could be applied in the UK to ensure that health care is available to all in a similar way to the NHS currently.

Hannan could have summed this up using his prodigious rhetorical skills in less than a minute on Fox if he had wished. He chose not to instead giving the impression that the US system is the one he favours when he manifestly does not. For the Tories to now complain that the left are misrepresenting him is to miss the point that Hannan has made it very easy for them to do just that and a great opportunity for the interesting ideas in "The Plan" to be more widely debated has been missed.

From my perspective, I think there is merit in "The Plan" idea for health care reform. As Charlotte has pointed out, it does not sound a million miles from what was proposed in the Orange Book a few years back by David Laws where an insurance based system would be used and the patient chooses the provider. That achieves similar ends (proper patient choice) through a slightly different mechanism. I know the contents of that book are the subject of debate within and outside the Lib Dems but my view is that alternatives need to be sensibly considered and I cannot see how the NHS in its current form can continue for the next 60 years. We have to properly debate reform.

Sadly it looks like it aint going to happen this time around. Advocates of reform need however to be much more clear in future to make it harder for their opponents to misrepresent their real views.

Perhaps Mr Hannan could bear this in mind the next time Mr Hannity invites him onto his show as he doubtless will. It may not be exactly what Fox News wants to hear but he should be unafraid to fully state his position.


Nik said...

What is "proper patient choice" though, and why would I (a patient) want it?

Mark Thompson said...

The ability to choose which hospital to go to and which doctor or specialist to see.

If I can bounce this back to you, why wouldn't you want to be able to choose?

Nik said...

The obvious answer is that ideally it shouldn't make any difference - they should all be of equal excellence. I recognise that is obvoiusly not the case, but I do think that is a better ideal to be working towards than letting the patient decide everything.

I am both a taxpayer and a frequent user of (some might say "drain on") the NHS. I think such services should be well-resourced enough (in terms of both assets and knowledge) for doctors (and other health workers) to be able to make decisions about my healthcare based on the assumption that what I want is for them to give me whatever treatment will benefit my health the most.

I have enough trouble deciding which variety of apples to buy. The last thing I want is to have to make decisions about actual important stuff, for which I have no qualifications. I would really rather not have the burden of responsibility for my own healthcare.

Similarly, I've noticed a slightly troubling trend lately whereby after describing symptoms to a GP (incidentally, I always answer "whoever's available" when they ask which doctor I want to see, unless I've been told previously by one of the GPs themselves to see a particular one for particular health concerns), they'll ask me "well what do you think it is?". So far I've managed to resist replying "I don't know, I didn't spend five years doing a medical degree, why don't you give me your thoughts?".

The only real choices I want from doctors are those of time and location - purely matters of convenience for me*.

Again, I do appreciate that I'm being idealistic here, but isn't it better to have the ultimate aim of making all doctors, hospitals etc. of a high standard than to put the onus on the patient to do the research, randomly pick the specialist or work out which hospital is least likely to give them MRSA?

Choice is a word with lots of positive connotations and I think it's a marvellous thing when applied to clothes, flavours of crisps, operating systems, consensual sexual practices etc. I think there's a danger of choice being automatically seen as a good thing in all contexts though, and I really don't believe that's the case.

*Obviously there are requests to avoid certain treatments for religious reasons, but I think those are beyond what we're talking about here.

Anyway, sorry chap - wasn't intending to do a big rant on your blog; I've just yet to be convinced of the case for patient choice.

Mark Thompson said...

Nik - no worries, rant away!

I fully understand your point and I may well feel the same in your position.

I should caveat what I am about to say by pointing out that I am not here to defend Hannan's position, or indeed the Orange Book section on this either. I am not an expert on health provision but it does strike me that the NHS as it is currently constituted is not sustainable in the long term. We will run out of money and indeed have almost tested this to its limit now.

The idea of allowing some sort of patient choice seems to me should drive up standards by giving incentives to the hospitals and individuals within them to perform better. There is a possibility of getting the benefit of the market-place whilst still retaining the universal provision that the NHS provides.

So I suppose what I am saying is that patient choice would eventually drive up standards across the board and even if half or more patients did not make a choice such as yourself, there would be enough who did to make this difference.

What annoys me most about this "debate" though is how you often just get shouting from all sides and insults like "THEY WANT TO DESTROY OUR NHS" (not from you I hasten to add!). Why can't this be debated sensibly?

Ed t said...

It's unfair to expect Hannan to outline his proposals for the UK on Fox News (and what if he had, actually, given the media unfairness?). Like it or not Americans are simply not interested in what Britain gets up to in real history. Furthermore, their primary concern is the organisational question of the so-called single payer system- which the NHS is an example of. It was in that context in which Hannan spoke. The falseness of the debate about Hannan's comments can be assessed by the wilful failure to recognise the context. It is an August story, but also a classic example of straw man politics. If I were Cameron, I'd send Hannan a private note of thanks for his sterling work on policy, and be quietly satisfied at the knowledge that Labour and their supporters in the press were this intellectually and socially bankrupt.

Mind you, the LibDem's Orange book sounds vaguely interesting... I've long held the view that the Lib Dems could be the centre party and the Cons on the right and we could fugedabout the past-it socialist party.

Mark Thompson said...

I don't think it's unfair to expect Hannan to be straight about what his view is. If I hadn't read his book I would have assumed that he agreed the US system is the best way forward - that's certainly the impression he gives during the interview.

If he had have been straight then at least there would have been more chance that the debate would have focussed on what he actually thinks rather than what he doesn't. Why is that so unreasonable for me to ask that? How many people who see his comments are realistically going to have read "The Plan" and thus secretly know what he actually thinks?

Constantly Furious said...

"patient choice would eventually drive up standards across the board and even if half or more patients did not make a choice such as yourself, there would be enough who did to make this difference"

Exactly. Egg-Fucking-Zactly.

I completely agree, Mark. That's the very heart of this argument, but it is not being debated. Because this isn't really about the NHS. As I've been ranting, this is all about cynical political opportunism - an easy way for Labour to score cheap points. God knows they've waited long enough for a chance, and now they're all over it.

You might have missed some of the frenzy, being away, but if Labour activists spent half the energy on analyzing and debating policy that they did on mindless, repetitive tweeting and blogging, Labour would be ahead in the polls.

(Welcome back, by the way)


dazmando said...


Damn its not working here.

Anyway this Mark is a very good point. Its easy to have a go at Daniel but ther is a very important debate and we should not shy away from it, clearly the NHS is not cheap and not sustainable in its current form however there are savings to be made now (we all know where Managers, admin and Quangos) Some kind of reform has always been needed but im afraid its one of those things that will happen due to dyer need like pension reform or climate change. It will all happen after some disaster dur to point scoring, followers, scardness and bloody human nature

Soho Politico said...

I think you are misrepresenting the basis of the row, for what it's worth. Hannan's failure to describe his own positive proposals in detail is not the reason he has been (rightly) condemned. The reason for the condemnation is his fundamental dishonesty about what nationalised healthcare is and means (note: it is not just criticism of the NHS that is at issue, but misleading and inaccurate criticism).

In the Hannity interview you refer to, Hannan claimed that, thanks in part to nationalised health services, Britain is 'maybe a couple of years behind Zimbabwe' in terms of poverty and debt. That is an astonishing example of scaremongering. You simply cannot have a reasonable debate about policy or reform with someone who is prepared to do that. That is why, as I have been urging on my own blog this week, Hannan ought to be seen not merely as an 'eccentric', as Cameron would have it, but rather as an ideologically driven culture-warrior in the Sarah Palin mould.

Matthew Huntbach said...

So I suppose what I am saying is that patient choice would eventually drive up standards across the board and even if half or more patients did not make a choice such as yourself, there would be enough who did to make this difference.

Would it? As Nik is saying, we aren't professionals so how are we to know what is best to choose? Might it not result in hospitals doing silly things because that pushes them up the league tables (which presumably are what you'd make your judgment on). So maybe they'd turn you away if you look like a poor case who might drag their figures down. Or they'd do unnecessary operations on you and tell you it's what they need if they could make a good profit from it, and doing it pushes them up the league table. Having to compete means they'd have to spend a lot of money hiring advertisers and PR people to sell themselves against the competitors - well, sell themselves only to the patients who aren't so sick they're likely to die and drag them down the league tables.

Look - I want health care given to me by people I can trust. If they're people competing for profit, I can't trust them because when they see me, they don't see a sick person, they see pound signs. I want to be told what they think through their experise is right for me, I want to be given the treatment they think is right. I don't want to be given whatever treatment they think will make them look good regardless as to its real worth.

kensington and chelsea said...

So what is needed is more clarity.