This week has seen the announcement of what is being billed as the biggest shake-up of the NHS since its inception. Whilst this would seem to be an overstatement, what is very interesting and seems to have been neglected is how the plans serve as a blueprint for the Tory project as a whole.The government has said that they want the bulk of responsibility for the £80bn NHS budget to be held by groups of GPs, as they are said to know what works best, and so are best placed to improve NHS efficiency and save money. This will be overseen by an independent board to avoid political intervention, separate from the Department of Health, which could in future concentrate on public health instead. The cynics have already talked of GPs ignorant of how to manage such large budgets and the confusion such a large shake-up will bring to an institution already in a state of 'permanent revolution'.
Yet what most people seem to have overlooked is that the plans being put in place for the NHS are not a one-off initiative, but a model which the government hopes to extend into many areas currently regarded as government-run. Indeed, we have already seen something similar in education with the academies announcement that has been causing a stir. This model is not merely a policy initiative but an attempt at fundamentally changing the way we expect to run our services, as fundamental as the privatisations of the 1980s.
The broad outline of the Conservative model is this: take a service that is currently run through central government such as education or health; abolish various layers of management and bureaucracy that have grown up over the years; give power and budgets instead to front-line staff and recipients of the service. This will usually be accompanied by an opening-up of the sector to some form of private enterprise, either through foundation status or getting individuals or businesses to set up services in the sector with government encouragement.
So far we have seen the outline of such a model in health and education, but they could easily go further. Sectors such as transport could see a similar initiative, with services run by local people in a consortium under an independent public body. The idea could produce new models in the private sector, with more partnership-based retailers such as John Lewis or even changing the face of retail banking through the introduction of truly local co-operative banks.
The optimists may cheer and the cynics may sneer, but one thing is for certain: the model is as bold as it is risky. It has the potential to change the way we expect our services to run, create a new localism and to engender a true people's capitalism through getting everyone involved in running the services they use. For the country's sake, let's hope it succeeds.
