News from nowhere

The small storm whipped up by Frank Dobson’s refusal in mid-June to rule out charges to patients for out-of-hours visits, and for so-called ‘hotel services’ in hospitals, remains a puzzle. Why get the press excited, give the Conservatives a chance to mock Labour’s championship of the NHS and feed the Liberal Democrats’ status as the ‘necessary tax rise’ party ?

Insider reports are confused, and give three different explanations. The first is that that Big Frank was still in election campaign mode, trying to be all things to almost all voters. This explanation is consistent with past experience, because he can be ponderous and few would call him politically nimble. The contrast with the cerebral Meacher, who preceded him in the shadow health job in the 1980s, and with his formidable successor Robin Cook, emphasises his style as a reliable caretaker, good at tub-thumping but not prone to pyrotechnics. Except that caretakers can make mistakes, hence the June debacle.

The second view sees conspiracy rather than cock-up. By refusing to rule out options which everyone wants ignored, Dobson will be able to denounce them later, to widespread relief, while doing something else objectionable — like not saving hospital X or not increasing budget Y. The June skirmish may have been Mandelsonian smoke to create the opportunity for a political gesture that will reinforce the image of New Labour as open-minded and undogmatic — see, we looked at all possibilities, and after much consultation we have rejected patient charges. Ideological, us? Never!

But News from Nowhereinformers think a third view is probably closer to the mark. Mr Dobson and the team don’t know what to do, so they are copying the Thatcher administration, which cast about for ideas throughout the 1980s before embarking on the internal market reforms. They are not in favour of charges at all, but they are stuck with the Tory legacy of a shambolic market, rising demand and a growing bill for NHS renovation. Somebody, somewhere, will come up with ideas that can work, and much debate about options could flush them out. Not that this will take much doing, because the best idea is increasing taxation, but getting it into the public arena in a way which allows the Minister to bow to pressure may take time. In other words, now is the moment for all good pressure groups to come to the aid of the government.

On the policy issue, a cursory look at the scientific literature on night visits shows that research has shifted from working out why people need services at night to simply counting their calls — a move from qualitative understanding to quantitative study that mirrors the mechanisation and commodification of the NHS.

Closer contact with the NHS may show Dobson’s team that the rise in night calls is a function of the services’ availability at a time of rising anxiety. Most of the work done by the burgeoning GP co-operatives is anxiety reduction, with the tax-payer footing the bill for an ever more complex system to do it. But if the service were not available, anxiety would be reduced in other ways. Better perhaps to simply shut the GP co-ops down than commodify them further with charges.