Health policy battleships: the Conservatives miss, and then hit – Health Policy Today, 4th August 2008

Two health policy stories stand out this weekend.  Both relate to information uncovered by Conservatives under the FOI Act and, like a game of battleships, one hits and the other misses.

Miss: claims the government is lying over copayments

The Sunday Times should have regular editorial meetings between its writers.  That way, we could be spared non-scoops like ‘people have been topping up in the NHS, despite the government saying they have not’.   One of the key points of the co-payment debate – led by the Sunday Times - has been to highlight an inconsistent application of the rules.  The Sunday Times has profiled people who have successfully topped up in hospitals that have allowed it, so the story hardly comes as a surprise.

The Sunday Times’ campaign on this issue has been helpful in breaking down some of the simplistic debate on health policy.  It has forced the left, who naturally recoil from any mention of private spending in the NHS, to realise that our health service is used in a complex range of ways and, indeed, the NHS itself operates within a mixed economy.  It has also forced them to try to reconcile the political with the personal.

Reports that some hospitals allow co-payments does not leave the Government’s position in ‘disarray’, as the rather sensationalist article has it.  As Alan Johnson said when he announced the Richards review of topping up, we need to gather examples of what is happening already within the NHS and try to find a consistency across the service.  

We know that some people have been able to top-up while others have been prevented from doing so.

What is interesting about the story, however, is that it could give us a picture of what happens across the NHS.  But either top ups are not occurring in as many places as previously reported or not all of the examples found are being shared with us.  The Sunday Times article cites five hospitals that have allowed co-payments: four in England and one in Wales, Bridgend.  There are probably more.

The story is obviously very political.  It was John Baron (Conservative, Billericay) who obtained the figures.  He quite reasonably notes that his findings “undermine the case of those who argue co-payments cannot exist within the NHS”.  

This pretty factual statement is reported as though nobody knew this.

It will be interesting to note how the Conservative front bench will respond.  There is no quote from any shadow minister in the story and all through the debate, they have been pretty quiet on the issue.  

It is not clear, to me at any rate, whether the FOI request came from John Baron personally or whether it was coordinated by the Conservative health team, as part of their research on co-payments.

There is an ongoing consultation from Andrew Lansley’s team on co-payments, but no sign, yet, of what it will say.  John Baron used to be part of Lansley’s health team, and it is clear that he would push for co-payments to be allowed across the board, but Lansley thus far has been cautious to push the issue too hard.

Like Alan Johnson, Andrew Lansley is worried about the prospect of two patients next to each other being treated in different ways because of their relative wealth. In many ways, he will be thinking through the same issues as the Government are.  Can co-payments be limited to cancer drugs or should they include all expensive drugs, such as those to treat Alzheimer’s?  Can co-payments be limited to drugs or once the principle has been accepted will they be introduced across the board.

Like poker players, Lansley and Johnson will show their hands at the same time.  The Conservative consultation ends in September; the Government review is due in October.

Hit: accusations that the Government is misleading the public on its commitment to local decision making

What is much more damaging to the Government and a bit of open goal for the opposition is Laura Donnelly’s piece in the Daily Telegraph.   It also reports data gathered by the Conservatives, this time on PCTs and their intention to introduce polyclinics.  

You will recall that during the height of the BMA’s Save our Surgeries campaign, the Government insisted that polyclinics were for London and elsewhere, they may be introduced, but only if the local PCT felt that was the way to go.

As I wrote here last Thursday (31 July), Geraldine Smith (Labour, Morecambe) has been raising questions about her local area.  In the last health questions before Parliament rose (22nd July) she said her PCT preferred to work with local GPs, but were being prevented from doing so - http://www.healthpolicyinsight.com/?q=node/134. In response, she drew the first admission from Alan Johnson that local PCTs were being overruled.  Johnson said the idea of GPs improving access had failed and going down that route was akin to putting money in the pockets of the BMA – a statement that I ridiculed.

Laura Donnelly reports that ‘half of the PCTs that responded said they would not consult on plans to build centres and some cited advice from the Department of Health as the reason for their decision.’

‘Several mentioned DoH advice, quietly issued in January, that there is no legal obligation to carry out a formal consultation, and that it is a matter for local discretion. Others said they could not consult on something which was a Government directive, or that they had not been given the time to seek the views of the public.’

'The problem here is that Alan Johnson has consistently been saying one thing, while doing another.'

It is, of course, okay for a Government to adopt any policy they like – and to be held account for that.  The problem here is that Alan Johnson has consistently been saying one thing, while doing another.  He has forcefully said that there is “no argument for imposing polyclinics”. He suggested that idea this was the case was the BMA lying or exaggerating for political effect.  A third of England’s (50 out of 152) PCTs will not be consulting with their local population at the behest of the DH. This suggests that Alan Johnson is the pot calling the BMA kettle black.

It is hard to disagree with Andrew Lansley’s comment: “Labour has claimed that they are not imposing polyclinics on local people, but these figures expose that lie for what it is.”