Anyone who questions any aspect of the way the NHS performs – whether in Scotland or England and Wales – soon becomes accustomed to being accused of harbouring some kind of ideological resentment towards the dear old thing. Ideological, of course, is a Bad Thing. It is supposed to indicate a preference for an evidence-free approach that places means above ends.
This works both ways, however. If (some of) the NHS’s critics are motivated by ideology many of its keenest defenders are no less moved by an ideological commitment to the service. Their ideological commitment, of course, is a Good Thing and not to be confused with the other kind of ideological commitment.
Sometimes this means that even stalwart defenders of the NHS must sacrifice what works for the greater purity of the service. If patients suffer as a consequence of this commitment then too bad. Let them wait. Their ailments are mere trifles when matched against the greater glory of the NHS itself. The little people do not count.
Consider this story from Scotland:
Health secretary Alex Neil has announced that ministers must approve significant spending by health boards on the private sector. Health boards often send patients to facilities operated by private firms, such as Bupa, if they cannot be treated within waiting time targets on the NHS.
This amounted to about £28 million last year and is expected to fall by a further £3m – from a total health budget of about £10 billion.
Interesting for a number of reasons. First, the sum involved is almost laughably trivial and close to a rounding error given the size of the NHS budget. Secondly, it is an example of ideology run rampant since, again, the amount of cash diverted to those dreadful private health companies is so small. Thirdly, it plainly does not matter if patients have to wait longer for treatment now than they might otherwise have had to. They will be treated, eventually, by virtuous public servants not be vicious private wreckers.
There is, as there always must be, a referendum angle to this too. The SNP want Scots to believe the only way to “save” the NHS is to vote for independence. This makes no sense whatsoever, of course, but it’s a nice line.
It makes no sense because, as Alex Neil and other MSPs will often remind you, Jeremy Hunt’s remit does not extend north of the border. Even before the Scottish parliament was established, the NHS, like education and much else, was run out of the Scottish Office, not from the English department of health. The systems have, most of the time, been largely similar. They have, nevertheless, been modestly distinct.
So god knows how Jeremy Hunt can wreck a service over which he has no great control. Perhaps he has magic powers or something. Gosh, he keeps them very well hidden, doesn’t he?
And, lo, Alex Neil will tell you this himself:
Neil has issued new guidance to all health boards which states they must submit plans for their use of the independent health sector, and all significant spending must now be agreed by ministers.
[...] “I have asked health boards to clearly set out in their plans for future years how they plan to use the private sector, and report back to me on how they will reduce their spending in this area.”
[...] “This should be seen in stark contrast to the competition, privatisation and complicated reforms being introduced in England that I believe threaten the very foundations on which the NHS is built.”
Since it is reported that fewer than 0.5% of NHS patients in Scotland are ever treated, even in part, by the private sector this might be thought a disproportionate over-reaction to a “problem” that scarcely exists. Then again, the problem is one of something working in practice but not in theory…
Moreover, it is a reminder that the SNP’s thirst to concentrate power, even on relatively trivial matters such as this, in Edinburgh is unquenchable. Anyone who thinks independence will solve that problem is hopelessly naive. Independence is actually one of the party’s more reasonable policies; it’s everything else that’s concerning (cf education, justice etc etc ad nauseam).
The best interests of individual patients? That’s a different matter entirely and not one that matters very much. At best it is a secondary concern. It’s the ideology, you see, not what works. Reform is just a club in London. And London is bad, too.