Tuesday, 28 November 2006

The myth of the postcode lottery belies the awful truth

Last night on Channel 4, John Snow presented a Dispatches on Britain’s Healthcare Lottery. According to Snow, healthcare is applied differently in different regions and as such a “postcode lottery” applies across the UK. He cited a gentleman in Wales who was not able to get treatment that was available to English patients across the border, and an arthritis sufferer who was denied treatment that was available to a women with a similar condition only a few miles away.

This concept of the postcode lottery is a fallacy. While there is no doubt that different Strategic Health Authorities and even NHS Trusts have different priorities, this is not a lottery. A lottery, were it to apply, would at least be fair, for the totally arbitrariness and randomness of such a system would mean that every patient had an equal chance of “winning” treatment, irrespective of other factors.

What we have instead is a postcode auction, with houses near good public services worth significantly more than houses where provision is poorer. I well remember an evening walk in Muswell Hill, when a friend pointed out that the houses on one side of the road were worth £100,000 more than those on the other side, because one side of the house was in the catchment area for a highly rated state school whereas the neighbouring school was far less well regarded.

This is a disgrace that points to the heart of the current Government’s public services failure. What both John Snow and the Labour Government seem not to understand is that differences in provision are unavoidable: schools and hospitals will always vary in quality – uniformity is a pipe-dream – and there will always have to be differing priorities in different areas. As long as citizens are parcelled up by district and told which health provider or which schools they may access, house prices will reflect the quality of public services and the rich will be able to access better services than the poor.

Where schools are concerned, this is probably one of the main reasons why social mobility has fallen in recent years; where once bright children from poor backgrounds could access good schools, they are now stuck with whatever school their parents can afford to live near. Thus poor people are obliged to send bright children to underperforming schools.

It is time decisions about services were taken away from bureaucrats and handed to citizens. Rather than public services being allocated by postcode, they should be selected by the user. The Government’s “choice” agenda is a nod to this, but it does not go nearly far enough. The Government should get out of direct provision of services. Education should be provided by a voucher scheme that allows poor parents to buy their way into good schools: as the money follows the pupils and the pupils follow success, failing institutions will be replaced by successful rivals and the overall quality of education will improve. This already happens in havens of Social Democracy such as Sweden.

As regards healthcare, Government should use the tax system to fund individual health insurance for every citizen, rather than try to provide health through a state monopoly. Thus patients would be able to access, through their insurance providers, whatever treatment they required, rather than being at the mercy of state planners who have decided that in a certain region a certain treatment does not meet the bureaucratic requirements.

The tired old phrase about “a postcode lottery” is a myth that belies the truth: a postcode auction that enables rich people to buy access – through higher house prices – to the best public services. This travesty is the inevitable outcome of state planning. It is time to move to a system for providing essential services that is truly fair. Power over their own health and over their children’s education must be returned to the people.


Jock Coats said...

Three little words:

James said...

What he said.

Tristan said...

LVT /and/ choice would work even better...

I don't see how LVT would solve the problem of the auction...

For healthcare I like the idea of compulsory, government backed, savings for health-care with catastrophe insurance. That avoids the imperfect information of the patient/insurance provider relationship (which is one of the big problems in the US)