Health targets?
Would politicians really choose to close hospitals in their opponents' constituencies and open them in their own? That's the question raised by which shows that community hospitals facing the chop are largely in Tory and Lib Dem seats. It's a follow-up to the paper's earlier report about health ministers getting together with the Labour Party chairman to discuss closures.
One of those involved in the development of health policy in this government told me many months ago - and before this current controversy - that too many new hospitals had been built in northern, Labour constituencies since 1997. It was a mirror of what the Tories had done - spending and building too much in southern, Conservative seats.
Now, this pattern may not only reflect party political favours - or what the Americans call "pork barrel" politics. The prime minister has responded to Tory charges that spending's much higher in his constituency than theirs by pointing to the fact that the mortality figures are much higher in County Durham than the Home Counties.
My instinct tells me that it's in the case of marginal decisions where party politics will make a difference. Where the health or economic case rests on a knife edge, the presence of a friendly or hostile MP could - and I do emphasise, could - make the difference.
The fashionable answer to this is to "take the politics out of the NHS" by setting up an independent NHS Board. Gordon Brown has flirted with one version of this. David Cameron has proposed another. Such an idea might take party politics out of the calculations (though the board - like all - would owe their existence, appointments and budget to the government of the day) but the risk is it might reduce political accountability. The debate will roll on.
I'm 
Comments
It never ceases to amaze me how low the Labour party will stoop - do they really think that the public will not respond by strengthening support against them? Desparation leads to desparate measures, in more ways than one! TB is well past the "quitting while ahead" point, and too arrogant (or perhaps pompous?) to see the damage he is causing. I continue to sit back and anjoy watching Labour thrashing itself to death - the longer they act like this and also prolong the leadership contest, the more chance the Tories have of getting in next time.
Reducing accountability to government will simply reduce accountability to public and patients further than it is already. Suggesting an arms length body to run the NHS allows politicians to dodge these difficult issues even more than they do now.
What is needed is true local accountability: the NHS should be run by local government as social services is. Accountability to local politicians will vastly improve accountability to local people and vastly increase their understanding of the issues. When local people have to choose between whether to close a hospital or to fund a new drug there will be much better insight into the reasons for decisions. It will also end the accusations of central funding decisions being made to disadvantage the opposition.
While this is a dynamite political issue, and clearly I am commenting on a Political Blog the facts of it are that this for me transcends politics. As far as I am concerned this is about my local hospital being closed and therefore if I or any of my family are involved in an accident we would now have to go 30+ miles to the nearest A&E, even in an ambulance on our congested roads that has got to put our lives at risk. No amount of savings is worth that.
To return though to the politics. The inferrence your source makes is that my local hospital is not needed because too many were built in the past in my opinion that is just plain wrong, If you then add the fact that this closure is happening because I live in a Conservative seat then frankly it is difficult to express how disgusted and appalled I am at how low this government has actually sunk.
Roll on the next election or failing that General Dannatt and what is left of the British Army
Interesting how transparent our political leaders and government have become in recent years. Even a bit of ordinary skulduggery like nobbling a candidate in a marginal can easily be spotted?
I suppose what concerns most of us out here in the hinterlands, like me in Chelsea is how this might affect our local facilities..
As the NHS has been geared up to be bureaucracy heavy and short on delivery, a bit like all government these days, it is always front end services which get cut and not the hierarchy that controls it.
It’s a sad fact of life that Mr Blair and Mr Browns models of control require such robust systems below them, that way they are always able to blame the mechanism and not the policy when overspending occurs. And budgets are still set by Brown. So in reality Brown is the cause of the problem and Labour policy, not the spenders in this case who have acted in good faith, even if they are incompetent.
And of course if as a consequence you can make adjustments to voting through your control of cash and spending, all the better, as it appears to be local and not central control who make these things happen and our service diminish. Clever lot these leaders.
Am I a cynic? Of course I have been taught so by our leaders, who will disavow their part in it, as if it were never their fault.
It's a fact: the NHS is riddled with waste, maladministration and possibly nepotism. I recall one unit head who begged for a new full time post within his department only to fill it with 2 part time workers (his wife and friend) who both worked the same hours so the issue remain unsolved. I know of an NHS department of managers that exists with the purpose of appointing other managers! The politicians fail to grasp the nettle for fear of Adlai Stevenson style political suicide and much as I hate to admit (being 46 and likely to need the NHS more in later life!) denationalisation, commercial consideration to the core business (health care) measured by overall success not merely cost is the answer to this connundrum. Who knows - if we have to pay for it then maybe - just maybe - we may take more care of ourselves!
Bob
Nick,
If it is pork barrel politics it's a very odd kind indeed. Community hospitals tend to be smaller, are able to offer a smaller range of services and are often the poor relations of the sector. So would you prefer, elector, for the government to spend on a well equipped hospital ten miles away or one offering, say, a little bone-setting and antenatal care in a crumby run-down building within a bus ride of home? If you and your fellow townspeople really do want the second, you'll have lobbied for it, hard and vociferously, locally. Imagine the placards, the shouting crowds, the taunts to visiting ministers. In short, if you really want to LOSE votes, take on local populism; you'd even create a rallying point for the local opposition politicians. Ministers would be mad to do this even in non-marginal, no hope, seats, since the state of the health service is a national issue and this image obsessed government would appear insensitive and blinkered.
Where pork barrel politics does show up is in the speed of development of large scale NHS facilities - i.e. bringing on the 'good news'. So, as ever, I expect that by mid way through 2008 the government will be announcing that they are bringing forward (in reality or in the sense used in that twilight world of the Treasury press release) capital plans for new faclities in large hospitals that just happen to be in marginals on Labour's hit list.
The idea of taking the politics out of the NHS is a great one, if you're a politician. It's too big for anyone to get to grips with, and there's always a Daily Mail story waiting to happen with some pensioner denied an operation, a cancer patient who didn't get the drugs. You don't get people happy with you for anything you do in it. So some MPs might be grateful to hand it over for someone else to get lynched.
The health professionals might like it, because some say that a major problem is the constantly changing structures - politicians can't have 'do nothing' as their policy, so political control means constant change.
Patients won't like it in the end, because any perception of influence over it will diminish. I'm not sure that's a bad thing though.
However, you started by talking about MPs influencing hospital closures etc. and I'm not sure they can take credit for that any more than for 'intervening' when a closure is put off. I agree with you that they can exert a small influence in the knife-edge case. The question that comes into my mind is whether people really understand teh job, power and influence of MPs and what they actually do?
Seems to me, and the Durham situation might confirm it, that what's going on is consolidation into a smaller number of larger hospitals - these are likely to be in population centres, so the countryside will suffer disproportionately, and there aren't so many Labour MPs there. It's not direct political favouritism, but it's a decision about how to provide services which is surely too political for an independent board.
I don't think that there's any doubt that there is some truth in the allegations. It is bound to be the case that an MP of the same political persuasion as the government is going to find it easier to lobby for more funding in their constituency.
It also stands to reason that the government is not going to risk losing marginal seats when another option, such as closing a hospital in a neighbouring constituency is available (especially if it is represented by a political opponent).
Creating a quango to run the NHS will not give the government a hiding place if things go wrong within the NHS. In fact, they will find that they get all of the criticism but none of the praise.
The facts speak fot themselves, the south coast is threatened with closure (or downgrading whatever that means) of Worthing and Chichester Hospitals; nearest alternates Brighton or Portsmouth,
The A27 must be the worst trunk road in the country after the predations of Prescott. Pity the aqmbulance drivers and patients faced with an emergency service drive in the gloom of a winter evening with the gridlock in full force.
In addition Bognor has a minor hospital, Littlehampton a hole in the ground (promises broken again).
Compare and contrast with the state of hospitals and linking road service elsewhere.
A subject for an A level question methinks.
If the Tories built "too many" hospitals in the South during their reign, might we not say that rather than building "too many" hospitals in the North, Labour are simply redressing the balance?
How can you take politics out of the NHS when it represents such a large proportion of public expenditure ie the taxses that people pay.
Clearly the government has been trying to make political advantage of the NHS in the same way that those who live in conservative and liberal councils pay for a much higher proportion of local government expenditure.
The recently leaked email correlating marginal seats with the hospital A&E closure decisions revealed the truth - health gerrymandering. Of the 6 most recently proposed PFI financed hospitals only one was situated in the south(in Devon). Only today there was a relevant comment in Have Your Say from a Chichester resident regarding the boy Madonna wants to adopt in Malawi - apparently his nearest hospital there is 40 miles away. Under current proposals to close the Chichester hospital A&E department local residents will have to travel more than 40 miles to Brighton for treatment - a clearly less than third world standard. Central government rate support 'grant' is used in exactly the same way - taxes raised in poor southern counties - East Kent, East Sussex and Cornwall are consistently redistributed to the north.
Health issues should be above politics and should never be compromised. Politicians should not stoop so low but should ensure that healthcare is available evenly throughout the country. The public is not so gullible and would eventually see through the misuse of public funds. Ministers should be ethical and should not play with people's health.
Four weeks ago, I announced in our local newspaper that, as a consultant at our local, and very threatened, hospital, I would be standing at the next election under the banner of "Save Bedford Hospital", a party which we have registered with the Electoral Commission.
The local response has been extraordinary and overwhelming, but politicians are terrified that enthusiastic amateurs are intruding in their cosy game of politics. As one senior political journalist (not Nick Robinson, but someone almost as important) said to me "people like you are the politicians' ultimate nightmare".
Unfortunately, the genie has been let out of the bottle, and we aren't going to go away
I live in Rochdale which was labour and changed to leb dem at the last election and since then our NHS and maternity wards are being closed. I suspected this might be the case and really it is only natural of any party to support their own constituents- i am not saying that it should be but lets face it- it is going to be. I am actually in support of an independent NHS board and I don't think it will reduce accountability but they would need to moniter the quango- in fact I think there needs to be some tougher controls on their spending etc!!!!
Setting up an independent NHS Board could be a good idea but not if devolution of power simply absolves political leadership of their ultimate responsibility. To ensure policymakers take responsibility they should agree to always use the NHS themselves by signing the petition organised by OurPetition.org. The petition asks ‘elected representatives of all UK political parties [to] voluntarily refrain from self-paid or insurance-paid medical care treatment.'
All politicians say they are committed to the NHS but less than 10% have to-date signed the health petition. 35 MPs signatories were Labour, 11 were Liberal Democrats. Only 1 MP signatory was a Conservative (and no, it was not Mr. Cameron.)
Under devolution the risks are increased that policymakers may choose to shift future blame in the face of a failed reform policy onto the leaders of the institution to which they have delegated power. To ensure that devolution under any NHS independence bill does not equate to policymaker absolution the public should pressure MPs to sign the 'acid test' of MP support for the NHS at www.ourpetition.org
Sorry, but the ´óÏó´«Ã½ should not be a soapbox for the views of Nick Robinson and his sneaky pro Tory agenda.
Where are the blogs about Cameron and his covert plans to dismantle the health service? The current ideological No Man's Land of Tory Policy? The "Cash for Access" Tory funding luncheons?
Speculation, Westminster gossip and backstabbing... everything except the facts. Very handy for the Tories to have a right wing propagandist working as a superannuated ´óÏó´«Ã½ pundit.
Can I request you move your 'blog' to www.blogger.com where it's not supported by license payers' money (but publish my comment)?
Surely the reality is that lower health spending is much more likely to accompany high mortality than vice versa, because 'old people' cost by far the most. The over 80s cost more than the over 70s; and the over 90s cost even more. If everyone dies young, the health service gets a relatively 'free ride'. Just look at the way health insurance premiums shoot up as the policyholders get older and older.
So do the majority of NHS trusts under financial pressure tend to have older populations?
There is a real dilemma over community hospitals. They are popular and politically sensitive. And they serve the small but important proportion of the population with no access to cars or money for taxis. But big regional hospitals deliver better healthcare and can train doctors better (because they handle a wider range of cases).
So no easy answer here, Nick. But I'm sure that at the margin all governments favour spending in consituencies with MPs from their party. Same with transport (look at rail schemes in Scotland).
Surely Labour can point out that if the Tories were overbuilding in their constituencies prior to 1997, then overbuilding in Labour constituencies now is merely redressing the balence. Of course if hospitals are being built exclusively in marginal constituencies (or formally Tory constituencies), that is a different matter.
But we must resist the idea that we should take the NHS out of political control. Political control is about accountability, it is about democracy. The more services that are privatised or taken out of direct government control, the less we become a democracy and the more government can come back with 'well we didn't do it.' What is needed is effective ways of holding government to account (at present there are none), not shifting more and more out of the hands of elected Ministers and into the hands of QUANGOs or the rip-off merchants of the quasi-private sector.
It is the pinnacle of cynicism how politicans manipulate the NHS to achieve greater power.
For a long time it has been obvious that hospitals are only closed or services drastically reduced in areas where the population is mainly white, UK-born. This is probably for two reasons, (a) because the minority ethnic citizens are thought more likely to vote for New Labour, and (b) because the white native population is perceived as being more passive and less likely to violently demonstrate if they believe their rights are being threatened.
It is noteworthy how many hospitals and services in the home counties have vanished, whilst apart from a few whimpers the population has silently accepted the cuts.
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Although the idea of politicians making decisios about where to build hospitals is unpleasant. It is worse for politicians to give away all the power we give them to people who we cannot kick out every election. It would be the end of democracy, and I think that is less desirable than a few extra services following marginal seats.
British governments are capable of this and much worse.
As a reality check for the nation consider this; given the rise in taxation over the last 30 years and the endless privatization of public assets, how long will it be before politicians have nothing to do all day except dictate how you live your life, and how to waste the taxes that no longer fund public services?
How about getting rid of the politics in politics and just ensuring that life is something worth having and not something of worth to governments.
So mortality is higher in the North so build more hospitals? Strange that only a week ago we were told that regional mortality differences were highly correlated to excessive consumption of cigarettes and calories. Conditions where hospital medical intervention has at best a very modest effect on morbidity and mortality.
As usual the statistics are used to tell the story according to political dogma of the week rather than informed realities. A bit like the recent difference of political view over the military one re the current situation in the Middle East.
And of course tonights scenario of two people who are such a risk to the public that they were subject to control orders but yet who have managed to disappear. According to a government minister "those who needed to know did know" when the first absconded months ago. No prentence there that this included the public who might get hurt or even worse, the politically unnacceptable impression that this government is incompetent.
I wonder why we might think that?
I find myself utterly unsurprised by this. I know that there are no levels to which New Labour will not sink to obtain re-election. I also know that they have been milking dry the cash cow of the hard-working classes who vote Tory for the last decade to feed their social welfare programmes.
Another Gordon Brown budget will just about do me in. Roll on April.
Well, my nearest hospital is in a safe Tory seat and that's getting a £100million redevelopment. Also it's quite nauseating to see our local Conservative MP smiling at the opening of a new health centre one minute and handing our flyers about NHS cuts the next.
It's interesting if you ask - "Should the politics be taken out of NHS decisions?" you might get one answer. If you instead to ask "Should NHS decisions be taken by unelected, unaccountable quangos?" you might get a rather different answer.
" * 8.
* At 01:40 PM on 16 Oct 2006,
* jdc wrote:
Seems to me, and the Durham situation might confirm it, that what's going on is consolidation into a smaller number of larger hospitals - these are likely to be in population centres, so the countryside will suffer disproportionately, and there aren't so many Labour MPs there. It's not direct political favouritism, but it's a decision about how to provide services which is surely too political for an independent board.
"
Interesting that you mention this. Kent and Sussex Hospital, in Tunbridge Wells, is to lose its A & E department (they are 'consulting' on it at the moment). That means that it's either Maidstone or East Grinstead for serious injuries - a minimum of a 30-minute journey.
Given that Tunbridge Wells and Tonbridge between them have a population of 200,000, one cannot help but wonder exactly HOW LARGE a population centre needs to be before it warrants an A & E department.
As we all know, this area of the UK is well-known for its Tory majority and I feel it has become increasingly so in the last 5 years - we are a target ripe for punishment for failing to adhere to Dear Leader's beliefs.
There could be a simpler reason for hospital closures being in Tory areas. Our own county of Gloucestershire is facing a large budget deficit and trying to close things all round.
Our MP complained. We have only 85% of the standard nhs grant. Ms Hewitt kindly explained that this is because we do not need it! Jill
If it were possible it would make sense to remove politics from health issues in UK but the NHS is far too big for one group of people to manage effectively and efficiently and in the best interests of people, patients. At a time when the population in UK is increasing with an alleged population of 61 million officially but possibly another 1 million people somewhere in the system, it is a nonsense that politicians are closing more and more local hospitals when in fact there is a need for more to serve local communities. In UK we have the appalling situation where there are now 529 unelected Quasi non-governmental organizations (Quangos) costing billions of pounds of taxpayers monies, for example, the Legal Service Commission - £2.1bn, Scottish Education Funding Council - £800m, Northern Health and Social Services Board - £550m and the Teacher Training Agency - £514.6m, many of which appear to do little or nothing, are useless or in fact duplicate the efforts of one another. Do we really need yet another unelected Quango to have control over an alleged budget of £90 billion per annum without very stringent rules and guidelines relating to responsibility and accountability?
Mark Gray is lucky to have a hospital only 10 miles away. Ours is 37 and for special things more like 60 miles.
There is a cottage hospital just 6 miles down the road where simple a&e
were carried out but not now. Roll on the day when the pilot 30 GP centres that can do the small things spreads to our part of the world.
An excellent blog
Dear Nick
Given that the Tories are at least a year away from formulating concrete policies, why doesn't the Prime Minister resign immediately and the new leader call an immediate General Election? The Tories will have to hastily cobble together a premature manifesto which the elctorate will not find credible, therefore letting Labour in to power yet again. I know he won't but it's worth putting the question to the P.M ' 'In the interests of your party, Prime Minister ...?'
Mark Edmondson
Lancaster
After newsnight (´óÏó´«Ã½) said that Cuba has the second best health service in the world in the teeth of USA/world economic sanctions isn`t about time we asked the Cubans to show us how to run our National Health Service after all the USA sends many of it`s medical students there because of the high degree of training in Cuba they can`t get that in the USA.Makes you wonder how good they would be if there were no sanctions?.Presently even with the USA embargo in place hundreds of americans on full scholarships study in Cuba.Canada is the worlds number one in health care.Canada is alone in banning the use of the private sector in health care unlike Britain who allows the private sector to soak up tax payers money for the very poor service they provide.
What is the tories policy on the N.H.S.? and lets not forget those 18years of tory rule when they clearly governed for the few and not the many and that is a fact.I would say this to the Times and any other newspaper STOP putting the boot into the N.H.S.AND GET BEHIND THE IDEA OF HEALTH CARE FOR ALL.