In Which Andy X-X-Tory Disagrees With David Cameron

I'm going to do something unusual and disagree with David Cameron (leader of the Conservatives, Great Britain's moderate-right opposition party, of which I am a member).

My problems are this:

  • Things which are in demand, yet free at the point of delivery, will always be oversubscribed.
  • Giving people choice about in-demand free stuff makes oversubscription even worse.

    In the UK, the NHS provides healthcare to anyone who needs it, free at the point of delivery, paid by taxes.

    Now it is pretty unusual for me to talk about the NHS, since I am rarely ill. In recent weeks, however, I have been suffering from some strange kind of lower back pain which seems related to needing to go for a painful wee every hour of the day (or night). To put it politely, summat's dicky with my kidneys or waterworks, and it is so bad that it is preventing me from sleeping or being able to concentrate whilst sat at my desk.

    Two months and three appointments with my doctor later, and there's still no end in sight. More worryingly, they haven't actually managed to get the hospital to analyse any of the three samples I've submitted in that time.

    And then, worst of all, there is booking a doctor's appointment. The amazing online doctor's appointment booking system that took the receptionist the best part of half an hour to issue me with a password for, yesterday (7th December) said that the earliest available appointment was the 2nd of January (3rd of January if I wanted to see my specific named doctor).

    Clearly, that is not an acceptable way to run a medical service; four weeks waiting time to see a doctor.

    Whilst I don't doubt the good intentions of the staff, both frontline and back-office, there is the simple fact that the NHS is massively oversubscribed.

    Not only is my local NHS surgery full of really needy people - the elderly and young families who can't afford private healthcare - but it is also having to deal with people like me, folk on a reasonable salary with a reasonably large company who provide medical insurance.

    Clearly, people should be encouraged to reduce the demand on the NHS. They should be encouraged to use private commercial healthcare whenever they can afford to do so.

    Yet David Cameron has scrapped one of the Conservative party's best policies of the last decade; the proposal to credit anyone who is referred by their GP to a specialist, with half the cost of NHS treatment if they pay for it privately.

    Supposing I am referred to a urologist by my doctor; the cost of a private appointment would be about 200 quid, and the wholesale cost to the NHS would be about a third of that - say 70 quid. Under the previous Conservative proposal, I'd get 35 quid (half of the NHS fee) towards that 200 quid if I went private. I'd get encouraged to remove myself from local NHS waiting lists, and the NHS saves half the money it'd have otherwise shelled out anyway.

    Now you may be thinking, "Ah! But most private medical is paid by company insurance. It doesn't come out of your pocket, and in any case, you're still winning on waiting list time!" but that's a fallacy. Most company medical insurance - mine included - has some surprisingly low ceilings for lots of treatments. For instance, my ceiling on specialist consultancy is 1000 quid per year. With each appointment costing £200 privately, I don't want to use it unless I'm absolutely desperate.

    And this means that without the credit, I'm being discouraged from going private. I'm being encouraged to stay on the NHS waiting list, blocking up a space that could be desperately needed by someone without medical insurance at all.

    Of course, it gets worse. There isn't just one NHS waiting list. Thanks to "choice", I can impose my unnecessary drain on NHS resources on any of half a dozen regional hospitals. I don't just have the power to bed-block in Gloucestershire Royal - I can deny someone in Wiltshire or Worcestershire a higher place in the queue instead! Remember, the NHS is massively over-subscribed; there are no NHS hospitals with "short" waiting lists, just hospitals with "long" and "very long" waiting lists.

    The cool thing about the Conservative party is that we actually do have a social concience. Sure, we don't like excess in social welfare, but we have a strong sense about what constitutes a minimum level of public service that no person must ever be allowed to fall below. The NHS is currently failing this test, and David Cameron's decision to scrap financial incentives to go private, represents spin over substance that will hinder the NHS still further.

    Indeed, it's the kind of spin that is reminiscent of my local NHS surgery, located in an expensive shiny new building, replete with "new paint smell", for which I can't get an appointment until a month from now.

    Public Domain - Andrew Oakley - 2006-12-07

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