Tony Abbott lost the health debate comprehensively. I suspect it was not because he had no health policy of his own, but rather that he was limited in the attacks he could launch on the Rudd policy because his policy would, in the end, be much the same. He was therefore limited to the “Kevin couldn't run a chook raffle” argument. The Prime Minister countered this with a combination of focus group tested language and a statesman-like demeanour. It was very effective.

Neither the Prime Minister's reform package or the limited proposals of the Opposition are likely to result in effective health reform. This is not based on a hunch, the policies have been road tested in the U.K. When Tony Blair was elected he perceived that Health was the issue that would ensure the longevity of New Labour. It became the focus of his attention. He doubled the money going into health and went on a major recruitment programme for medical staff. Funding was centrally controlled, to the extent that 10 Downing Street micro managed the process. Finance was provided on an activity basis with the most efficient hospitals providing the benchmarks. Does this sound familiar?

The only problem with the Blair reforms was, that for all the investment in the UK health sector, the outcomes got worse.

What went wrong? Julian Le Grand, who was an adviser to Tony Blair on health policy said that the system went through three phases firstly they asked the experts (similar to the Bennett Review in Australia) and that was a total failure, then they ditched the experts and asked the bureaucrats and that was a total failure, so in the end they started to ask the customers and at that stage things started to improve.

The consequence of consulting the public was that Tony Blair established Foundation Hospitals, which were very much along the lines of Abbott's proposal for local boards. The foundation hospitals were freed totally from any bureaucratic control. The result was that of the top 36 hospitals for customer service and efficiency 35 were foundation hospitals.

The conclusion was that the system needed more autonomy, less central control and more competition between providers. As the think tank “Policy Exchange” described it;

“NHS healthcare providers need to begin to relish their autonomy
and to use it to develop their institutions. They ought to be
well-placed to acquire weak providers and turn them into successes,
and in the process build chains of strong institutions and services
that are capable of resisting central control and rising above the
pressures this seeks to exert. But so far these changes have been
slow to emerge.”

To achieve a dynamic and patient focussed health system the dead hand of centralised bureaucracy has to be eliminated from the structure.

This begs the question of whether Rudd and Abbott would be prepared to establish a system, which was not centrally controlled.

Ideally such a system would leave the spending choices in the hands of the consumer together with their G.P. The G.P. would be a combination of client adviser and case manager, commissioning and paying for other services on the patients behalf, and ensuring they got value for money.

So far the suggested Rudd/Abbott health reforms have barely scratched the surface of the issues to be dealt with. As always implementation will be the test of the efficacy of the policies regardless of who is in charge.