Scotland’s independent think tank
Scotland’s independent think tank

Geoff Mawdsley: A third way to improve the NHS – The Scotsman

This article by Geoff Mawdsley appeared in the Scotsman.

Writing in The Scotsman last month, Professor Allyson Pollock posed the question: Can it really be true that we can no longer afford the NHS? For me, a better and far more relevant question is: How can we reform the NHS to make it more responsive to patients and at the same time provide better value for money?

Whether we can afford the NHS in its current form is looking at the issue through the wrong lens. How we can improve it for the benefit of all by introducing wider choice is what really needs to be examined.

Diversity in the provision of all public services – and the health service especially – is the key to achieving higher standards. However, in a report published today entitled Voluntary Power, my colleagues and I make it clear that achieving greater choice does not depend solely on public and private sector provision, but the expansion of the third or voluntary sector.

The view that a public sector monopoly is the best way of delivering healthcare is not one I share. I am sure that Prof Pollock opposes monopolies in the private sector because they work against the public interest. That is certainly true, but a monopoly is a monopoly and just because it is in the public sector does not make it any more likely to serve the interests of service users.

The idea that there is only one right way to deliver healthcare is essentially ideological. I have no problem with the public sector delivering services. However, it should not grant itself a monopoly, but instead create a level playing field in which others are also able to provide services. In such an environment, creativity thrives and leads to higher standards, whereas monopoly control of any activity tends to have a stultifying effect.

We need to take a far more realistic view of the performance of our own health service and take off the ideological blinkers. Yes, there have been improvements over recent years, but we lag behind other countries when it comes to key indicators. For example, according to a study by the European Journal of Cancer, Scotland trails almost all other European countries in terms of the percentage of cancer patients cured as well as survival rates. Surely, such figures should at least lead us to examine ways in which we might improve our health service.

That is why it is unhelpful, as well as intellectually dishonest, to pretend that the choice we face is between a public sector monopoly and the US system of healthcare.

As director of the Centre for International Public Health Policy at Edinburgh University, presumably Prof Pollock is aware of the many alternative systems that operate across western Europe. Yet, conveniently, she chooses to ignore them. It is these systems that we should be looking at, and learning from, because many deliver better health outcomes and high levels of patient satisfaction.

There are the Scandinavian systems where healthcare is largely taxpayer-funded, but delivered through local authorities and the insurance-based systems such as the Netherlands. There is no such thing as a perfect healthcare system, but these systems share common features and typically give patients more choice from a wider range of providers.

There is absolutely no reason why healthcare in Scotland cannot assume some of these features while preserving its essential ethos.

Many other European countries pride themselves on guaranteeing universal access to healthcare irrespective of ability to pay. This principle, quite rightly, underpins our own health service and it should certainly be preserved. However, it is perfectly compatible with greater diversity of provision.

The claim that diversity of provision inevitably means the “commercialisation” or “privatisation” of the health service is a gross distortion of the truth and, frankly, an insult to the voluntary sector organisations already involved in providing health services.

Most of us would agree that the many charitable hospices which operate within Scotland are examples of all that is best in our health service. Our voluntary sector consultation has thrown up numerous other examples of people volunteering to support the health service or organisations being established to cater for particular local needs. It is the third sector that provides much of what little diversity and choice that currently exists in our public services and there is plenty of scope for extending the role of the third sector within healthcare. And this should not be seen as a way of saving money. Although this may be the case, the real value of the voluntary sector is its ability to do things differently and often in a manner more personalised to services users.

What we are calling for is an end to public sector monopolies in the provision of public services such as healthcare and an environment which would give third-sector organisations the opportunity to deliver such services.

The key to this is public choice. Our proposals to reform health would ensure that public funding reflected choices made by people and we know that people will often look to third-sector providers because they frequently offer more personalised, compassionate and innovative approaches.

The essential starting point for reform, we believe, is a mechanism which empowers patients through choice.