When is a market not a market?
That is the question that remains unanswered from Labour's laborious 36-page policy statement Renewing the NHS.
The second paragraph tells the main story: the Party is terrified of proposing any serious changes:
"It is clear that it is neither possible nor desirable to turn the clock back. Nor is there any appetite in the health service for huge upheaval. We do not intend to replace one dogmatic approach with another."
With big changes rejected, it is therefore the Tories' dogmatic approach which remains the dominant factor in the new Labour plans.
The central feature of the Thatcherite reforms was the split between the purchasing and provisioh of care, embodied in the separation of Trusts from health authorities.
Labour has taken the bold step of capitulating to this change. "Labour believes that the planning and delivery of care are distinct responsibilities. They should be kept separate. Health authorities will remain separate from the hospitals they fund. Hospitals will manage their own affairs."
Bureaucratic
As a consequence of this, bour rejects the market, it cratic excesses of the present GP Fundholding, to be reby which GPs in each locality the commissioning and planNeither the health authoriBoards will be elected or acformal owners of the assets managers will no longer be The Labour policy carries a fairly radical critique of many aspects of the Tory policies, but is much more evasive about what a Labour government would do instead.
There is no reference anywhere to the global allocation of resources to the NHS, leaving the clear implication that the cash-driven cuts and closures which have already been endorsed would carry on if Margaret Beckett were in charge.
The fiasco of the recent Commons debate on London hospital closures, where Labour categorically refused to promise to halt or reverse the cuts has now been consolidated as policy, even while Labour scores cheap points by denouncing the loss of Guy's Bart's and other prestigious hospitals.
Costings
Similarly, Labour has made political capital out of the burgeoning costs of NHS bureaucracy under the Tory reforms, but its own policies would retain almost all the present functions to draw up the costing of each item of treatment for comparison with other hospitals, and to ensure hospitals run within rigid cash limits.
As in education, Labour would continue the discredited Tory league tables comparing hospital performance.
Compulsory tendering of hospital ancillary services would be ended, but existing contracts with private firms would remain untouched.
None of the growing number of top NHS managers would be laid off; they would be reassigned: the overhead costs would remain at their inflated Nor will Labour break from its long-standing support for the Tory privatisation of community care, with the imposition of means- tested charges. Instead all they promise is a Royal Commission to investigate the problems, which will shelve the issue for years ahead.
The policy says virtually nothing that will enthuse or reassure health workers or health campaigners, and represents a major wasted opportunity to win electoral support on a key area of Tory weakness.
Embarrassment Blair's timid policy today could prove to be a major embarrassment tomorrow. Tories will have a field day exploiting the bureaucracy and waste that will be rampant under Labour.
Beckett and co. have to be told by health unions, Labour Parties and other bodies that these half-baked policies are a liability, and should be ditched.