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Winner takes all

The three main political parties are full of ideas ahead of an election, especailly when it comes to healthcare and the NHS, but will any of them work?
Business people riding racing bikes

Political parties are full of ideas ahead of an election, but will any of them work?

By the time you are read this instalment of the machinations of my deranged mind, I will be winging my way to a former colony, on the other side of the world.

A conference in Sydney, a couple of workshops in Canberra. There's no sense in rushing back. As a globetrotting, jet-setter, I have responsibilities: there are locals on Bondi Beach who will be anxious to admire my rippling frame and surfing skills; the Anangu will expect me to spend a few dollars on a souvenir of Uluru, as us international anthropologists know it - local Aboriginal tribe and Ayers Rock to you - and, the Great Barrier Reef ecological project will need the endorsement of this global, environmental role-model. It's a dirty business but someone has to do it.

No sense in rushing back. Indeed, I intend to avoid coming back for as long as possible. Firstly, two 18-hour flights can't be any good for you. I do the walking up and down, the toe-wiggling and drink water but I can't get on with the stockings. I find the suspender belt chafes.

Secondly, it is highly likely you will be in the throes of a general election campaign. My spies tell me it is more likely to be sooner than later. A good time to be away.

The political outlook seems bleak. There is no point in thinking about the Lib Dems, they're never going to have a house-warming at Number 10 and increasingly remind me of Billy Bunter and the Ink Monitors.

Then there is the living version of Madame Tussauds, otherwise known as the Tory Party. A house-warming at Number 10? No chance, and anyway they don't deserve it. Tory health policy is dangerous. I mean dangerous in the sense that it is so ludicrous that it puts you in danger of falling into hysterical fits of uncontrollable laughter that could end in a busted gusset, or a burst something or other.

I know nothing about schools and roads and crime, but I think I can claim a more than average understanding of health service policy.

It leads me to the conclusion that if the Tory policy on everything else is as badly thought through as their health policy seems to be, please be sure they never get close to running a whelk stall, never mind the country.

The Tories want matrons with the power to close wards infected with MRSA. What do you do with the infected patients? 'Move them around the hospital, to another ward, so they can infect everyone else!' Hysterical, isn't it?

And of course, let's not forget: close a ward on Monday, decontaminate it on Tuesday and Wednesday, open it for patients on Thursday and it is as likely as not to be re-infected by Friday. Hilarious!

The Tories don't understand that MRSA comes in through the front door, carried by patients and staff. The answer is to test all trauma and elective patients. Barrier nurse the infected trauma patients and send infected, elective patients home with some antibiotics and tell them not to come back until they test clear. Then, test all clinical staff and send the carriers off on gardening leave until the antibiotics have done the job and they, too, are clear.

Too difficult? Well, believe it or not, that's just what they do in the Netherlands - of all places - where the incidence of MRSA is about 1 per cent. For the record, here it is 44 per cent.

Oh, and let's not forget hand washing. Give me a politician who will make failure to hand-wash a hanging offence, and I'll fly back and vote for them. We need hand washing marshals not floor washing matrons.

The entertainers 

The Tories are also very entertaining with their practical jokes around vouchers. The idea? If you go private for treatment, they will pay you the difference between the NHS tariff and the private hospital cost.

But there is no private sector in the UK, just a muddle of insurers, charities and not-for-profit organisations that provide the infrastructure for NHS doctors to moonlight. Stoke the private sector and what do you get? NHS consultants, who know a bob or two when they sniff it, making sure they have long waiting lists to feed their private sector income.

Let's not forget the effect of this barmy idea on private sector cost inflation: if the government chips in, prices go up. So, the Tories are a joke but what about the Labour Party? Labour has yet to publish its manifesto, so you will have to rely on my predictions.

There are four ideas that gurus and policy wonks have been whispering: convergence, the power of choice, the role of the citizen and deregulation.

Convergence runs like this: local government is accountable, unpopular and doesn't have much to do. Health is popular, has a democratic deficit and has too much to do. Merge, or converge, the management of the two, have people elect mayors and hospital bosses and vote on local priorities.

Local government is in charge of more of the local economy, involving more local people and bingo, it is reinvigorated.

Choice with power: people with chronic and long-term conditions have a pretty rough time. Give them vouchers to spend on their care and they will sort out what they want. Mogadon, a herb pillow or a massage. Let people spend their own money on their own care. Meals on wheels, or lunch at the pub? Let the people choose.

Role of the citizen: involves more people in the development of services and you can expect more from them. If you get recalcitrant parents with wayward kids involved with the school, truancy levels drop. Get obese smokers involved with healthcare policy decisions and they will see lifestyle issues are personal choices that not only they pay for - we all do.

Deregulation? The Pharmaceutical Price Regulatory Scheme will go, more drugs will be available over-the-counter and co-payments for a new category of me-too drugs is a certainty. So, that's the election sorted - apart from that, life's a beach!

The Author 
Roy Lilley is a healthcare author and broadcaster. He has written several books and is well known for his sometimes controversial opinions

2nd September 2008


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