Wednesday 25 February 2015

Ukip: an unhealthy policy

The NHS: Undermanaged, as it happens.

This week marked the launch of Ukip's health "policy". As expected, it isn't an integrated, structured approach. It's the usual slapdash feel-good claptrap you would expect from Ukip.

Louise Bours has no background in health, but then I don't either. What matters is the mental architecture and the approach to policy making, and the ability to ask the right questions. You only have to listen to her to know not a great deal goes on between her ears. It's true that's standard fare for most wannabe MPs and I can point you in the direction of some equally thick and crass Tories and Labourites. But here is another wasted opportunity for Ukip to hit back with something credible and competent.

I'm not going to do a full dissection. The full force of Twitter is being thrown at this policy and it will not survive the trials. The problem with Ukip bilge is it takes mammoth effort to deconstruct such awesome stupidity and their stupidity out-paces my analytical and research ability. Stupidity is a renewable resource for Ukip. It never runs out.

Most amusingly, like all parties, Ukip criticizes top-down reorganisatons right before outlining a top down reorgnaisation. Hilariously we see phrases like "Nurse training should take place on the ward, not in a university lecture theatre". As it happens we have probably the best nurse training in the world, where there is both hands on and lecture theatre training, both of which are necessary - and Bours would know this had she done any actual research whatsoever. Or chatted to a nurse for five minutes. You do start to wonder if the lady has even visited planet Earth.

But what we really see from Bours is a complete inability to connect the dots. You can't possibly fix something until you have identified the point of failure(s) - and Ukip wouldn't because it isn't interested is such grubby details. There were serious lessons to be learned from the Rotherham scandal, but Ukip cherry-picked their easy, lazy narrative about political correctness and that was that. Consequently, because they have no pool of knowledge from which to draw, and an allergy to detail, we get policies like this:
  • Abolish CQC- inspections would be taken up by local health board, who would also be encouraged to take evidence from whistleblowers and patients with grievances. The media have closed down more failing establishments than CQC
The point of central regulators is their independence and objective distance. Rotherham council is a prime example of what a closed shop looks like. Local authorities inspecting themselves will always find themselves innocent - and elected officials never like to look bad and so will derail anything embarrassing if it saves their own hide (sound familiar?). This is the model Ukip is essentially proposing here.

For sure the Care Quality Commission has not closed many establishments. It's not their job to. Their job is to improve standards. Closing an establishment down is a last resort. Nobody wants it. Not councils, not operators and not the patient if corrective measures and recommendations are followed. To close an establishment down creates a costs money and creates a crisis where previously none existed. The CQC doesn't often close down failing establishments because often it doesn't need to. It has the tools it needs to close serious offenders and it does use them. If the media is closing establishments down then that speaks to the weakness of authorities in making their case - taking the easy option.

What's really needed here is the same thing Rotherham needs: a formalised and independent complaints body acting independently of both regulator and operator to adjudicate on whether complaints have been properly investigated. An interesting proposal has come to light that Police and Crime Commissioners should act as a complaints body, one that exists primarily as a hostile external agency. The same or similar would be a good start.

Similarly illiterate is the proposal to merge social care. Social care is an integral part of council services which works more closely with the police, environmental health, local schools and care homes. It is that way for a reason. It's true there is a disconnect between each agency but if Bours knew anything about local authorities she would know the same dynamic exists everywhere. One of the first things you do when constructing policy is to find out why. The answers are tucked away in all those reports that Ukip doesn't read.

The Kipper mindset really believes everything is as bad as the Daily Mail says it is. It isn't. In places it's bad, but it's not all bad. Bours says that "UKIP, the people’s army, have asked the people what they want the NHS to be. Real people, people like you, not Westminster focus groups". What this translates to is "We disregarded a whole host of research and evidence that show satisfaction in the NHS has risen sharply and instead we asked our members who mainly read the Daily Express for their worthless opinions".

There is a huge disconnect between perception and reality. Some areas of the NHS are indeed the envy of the world, where you couldn't get better service, but in other areas are failing to cope not least because it is under managed. Bours complains about red tape and the "burden of unnecessary data collection" but if my experience of Social Services is anything to go by, record keeping is far from pointless and if it was done well, there wouldn't be the disconnect she speaks of between social care and clinical practices. This is not something to plough into with broad-brush assumptions.

This really is shambolic, lazy, illiterate stuff by someone who has no instinct for systems or structures or even policy, and what's worse, she has the arrogance to presume a working understanding of a mammoth and intricate system like the NHS in just a few months. We see plenty references to anecdotes but no actual reference to evidence.

This policy is designed to address issues Ukip thinks exist rather than the ones which actually exist, because it is informed by the bog-standard right wing mantras of waste and bureaucracy, failing PFI contracts and, of course, immigrants. Some of which is based on entirely valid observations but the specifics really matter. You'd need to look at the characteristics of the failures to devise a system that worked, rather than air a rag-bag of populist incantations.

This is Ukip all over. The arrogance of ignorance. This is the party that thinks we can simply pull out of the EU, leave the single market overnight and that there are no economic consequences because reasons. (whatever Nige can riff off). Now that same ignorance is applied to the NHS. Meanwhile, Kippers have lambasted Channel 4 for presenting the view that a Ukip government would be a catastrophic mess that would bring the country to its knees. On the basis of the above, can you really blame them for thinking that? I can't. This is a masterclass in applied ignorance.

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