For better, for worse.

The NHS is getting worse under Labour in Wales.  In England the NHS is getting worse under the Conservatives.  And in Scotland the NHS is getting worse under the SNP.  So there you have it, not one of the governing parties can run the NHS in the patch where they are dominant.

Actually, I think this should be no surprise to anyone for three reasons.  First is, our expectations of what the NHS can do are ridiculously high.  It won’t keep us alive indefinitely.  We have to get used to the fact that no matter how much taxpayers money you pour into the NHS, it will never be enough.

Second, whether you think a healthcare system is good or not depends on how you look at the figures.  Washington based Commonwealth Fund for example rates the UK top.  But on a narrow raft of measures.  Many don’t agree with the Commonwealth Fund about what should be measured, and how the results should be weighted.  A survey on health-care efficiency by Bloomberg recently chose Hong Kong, Singapore and Japan as the best performers, based on their efficiency.  Adding greater weight to patient choice, for example, might reshuffle the rankings.  The Commonwealth Fund most values equity and access, and so rewards the systems where it finds these.  But change the weighting given to each category, as Bloomberg does, and you can quickly change the outcome.  So when it comes to judging the world’s health systems, preferences and values guide conclusions, as well as raw data.  So choose what surveys you look at carefully.

The third point is this.  Governments simply are incapable of running an NHS.  I think that’s pretty obvious to most people.  How about all a government should do should be to set the parameters, give the money to a commissioning body on a 20 year rolling contract and let them get on with it.  Free from political interference.  Let the NHS concept of free at the point of delivery flourish.  But endow it with the opportunism of innovation and free thinking.   But for that to happen the politicians have to agree that the NHS needs to end its monolithic sole provider status.  Only then will innovation and fresh thinking waft through the wards.  

But of course, that will never happen.  The politicians have no desire to get together and give up the one thing they can use as an emotional battering ram come election time against each other.

So, over the next few weeks, think what you will be asking the candidates in your constituency, assuming that actual candidate ever comes to your doorstep.  If they start to warble on about investing your taxpayers money, or waiting times or whatever, just stop them and ask them one simple question.  “If you care about the NHS, will you agree a consensus with the other parties for the long term and agree a funding strategy and have no political interference for 20 years and allow the clinicians, health economists and health management professionals the freedom to make the NHS do what it was intended to do.  Care for us at our point of need.”

I think we know what their answer will be.