Obstructing patient mobility won’t improve health standards

There is an ongoing struggle between Whitehall and Brussels to see who will undermine the liberalising measures of whom. Today, it is bureaucrats in Whitehall who are objecting to an European effort to liberalise the market in one of the most essential services: healthcare.

In 26 September 2006 the European Commission launched a consultation on a legal framework to enhance cooperation between member states’ health systems. This month it stated that it was not necessary to get approval from one’s national healthcare provider or health ministry before travelling to a neighbouring EU member for treatment.

This is causing panic in the NHS. On the one hand, they may be called upon to reimburse unlimited numbers of patients – whereas individual Primary Care Trusts and/or the National Institute for Health and Clinical Excellence may approve or decline treatment based on cost, they would not be able to decline treatment abroad.

On the other hand, the NHS is understandably concerned about the competition this will impose. Figures from the NHS examined by organisations such as The King’s Fund suggest that relative to the wealth of our population and the amount we spend on healthcare, tens of thousands more Britons die of cancer and heart disease as the averages for the EU or the OECD (the club of 30 rich countries).

The Stockholm Network sums up the problem nicely: “The problem appears to be the [European] Commission’s application of admirably free-market principles to an industry which remains dominated by state provision in large swathes of the continent.” Unfortunately, the vested interests have the ear of ministers. “Only a system where market principles of open competition and profit motivation prevail can prevent this commendable proposal for freer movement being thrown out by national governments.”

So if you’re struggling to find an NHS dentist, why not hop on a no-frills flight to Budapest and let an excellent Hungarian dentist do the work. Better than queuing up the street in winter in the hope that the NHS will do the work.

The fine Labour tradition of cynical populism

I cannot possibly match the pith of the eloquent Cicero, who wrote his own short word about Hazel Blears. But words must be written.

Hazel Blears, the Labour Party Chair, has attended a protest in Salford to object to Government policy that will close the maternity ward in her local area. Defending her actions, Ms. Blears said “As a constituency MP, I am representing the strong feelings of my constituents. The people of Salford and Eccles come first.”

Actually, they don’t. Ms. Blears has clearly forgotten (if she ever knew) Edmund Burkes famous dictum that constituents do not elect a Member for Bristol (or Salford) but a Member of Parliament. Though Ms. Blears represents her constituents at Westminster, her duty is to make decisions in the national interest based on their needs and beliefs, not to bring home barrel loads of pork.

Of course, were Ms. Blears a humble back bencher she could be forgiven for defending local interests against national policy. But she is not. Ms. Blears is a Cabinet Minister (without portfolio – that is to say a politically-appointed drain on the public fisc) and as such shares responsibility for the very policy to which she is now objecting. Perhaps she has also forgotten (if she ever knew) the concept of Cabinet Collective Responsibility. While she may argue her point vociferously in camera across the Cabinet table, in public she must either support the policy or resign.

Of course, the Labour Party – which has never had much respect for political conventions or the constitution of government – has been here before. In 1975, Harold Wilson suspended collective responsibility during the referendum on whether to remain within the Common Market.

More recently, in another example of cynical populism, Hilary Benn (whose redoubtable father had been one of the chief protagonists in the 1975 debate) joined the Make Poverty History and environmental campaigners that marched to Gleneagles. In fact, neither Mr. Benn nor his Cabinet colleagues had any intention of implementing the policies demanded by this (largely anti-capitalist and anti-globalisation) crowd. But in classic New Labour fashion, they wanted some of the celebrity and the veneer of rebellion that attached to this youthful and spontaneous movement, so they despatched one of their more youthful-looking and more spontaneous Ministers to rub shoulders with the moral glitterati.

This cynical populism is a disgrace. It insults both the intelligence of the voters and the passion of the protesters. More importantly, it undermines the much-needed and serious policy debate that is required. The National Health Service needs reform, and global poverty and environmental degradation need addressing. The solution to these challenges will be found in the complex and difficult world of politics, where tough choices must be made for long-term objectives. This requires Government to identify the best approach, to shape a policy and to implement it. As with all changes of policy, there will be some losers, but hopefully there will be more winners and overall we will live in a better place. If that is not the result of the policy, it should not be implemented; if it is, it should be pushed with enthusiasm by the whole of Government.

If Ms. Blears, Mr. Benn or any other member of the Government feels uncomfortable with its programme, they should resign from the Government. But few now have the honour or conviction of Geoffrey Howe or Robin Cook.