Blair repeats the Stockholm sea change

By Johan Hjertqvist,
Director, The Timbro Health Unit (Timbro is Sweden’s leading public policy think tank: ) Stockholm, Sweden

Health care is becoming more and more of a political issue in Britain. Long waiting lists, poor response and low standards have led to rising popular discontent. The political parties are outbidding one another with promises of improvement. Rather like Sweden …

One thing, though, is very different. In Britain it is the Government which is now taking radical steps to transform the NHS. Just as in Sweden, “more money” has for many years been counted on as the recipe for putting things right. But the Blair administration has gradually come to see that pouring new millions into a malfunctioning system only serves to perpetuate the problems. And so now the NHS is to be reformed, from monopoly and bureaucracy to decentralisation and a consumer focus. It is above all the supply side which is now to be made more efficient.

The startling thing about all this is that New Labour has derived most of the inspiration for its reform from the Stockholm County Council, whose “market health care” is attracting a great deal of interest, not only among the two main British political parties but also in countries like Canada and the Netherlands, for example. Both Blair advisers and Tory representatives have paid several visits to Stockholm and, in talks with myself and others, expressed their admiration for the pragmatic modernisation of health care that has been introduced here (growing numbers of Canadians come here as well, in response to my recent visits to Canada).

So what does Blair’s new approach add up to? Much of it has a familiar ring to Stockholmers:

Waiting periods for treatment are to be reduced to 3 months at most (i.e. the availability now applying in the Stockholm region), though not until 2008.
“Perverse incentives” within the NHS are to be replaced with healthy ones. Hospitals are to be paid for what they actually deliver (the equivalent of Stockholm’s DRG system).
British patients will be able to choose freely between care providers, so as to reduce waiting times and improve quality. Just as in Stockholm, mandators will be required to inform people of the options available to them.
To strengthen freedom of choice and availability, co-operation will have to be developed with publicly funded, private care providers. These are to be contracted, roughly on the same lines as in the Stockholm County Council.
Independent hospitals are to be introduced under NHS auspices.
With this combination of decentralisation, consumer influence and productivity incentives, the Government is confident of remoulding the NHS. Blair’s conclusion is that the structure still surviving from 1948, the year of its foundation, is now obsolete and stands in the way of necessary renewal.

But the Stockholm County Council is not the only source of inspiration. Elements of Sweden’s “national model” are now also being exported to the UK. Local authorities, for example, are to be made financially responsible for elderly bed-blockers, and budgeting responsibility is to be moved down to Primary Care Trusts, which will control 75 per cent of all NHS funding allocations (on the same lines as Swedish county councils, one might say).

Talking to Blair’s NHS advisers, one is above all struck by the pragmatic view which they take of developments in the Stockholm County Council and other “reformist county councils”.

To their way of looking at things, the organisation of health care production in one way or another has nothing to do with “right” or “left”, “egoism” or “solidarity”. As they see it, in a changing world, public health care cannot stand still. If it does, there is an imminent risk of failure and crises of confidence.

And so they are looking round for best practices, and have evidently found quite a number of them in the Stockholm region, but also in other parts of Sweden. But that which, to Tony Blair, is an example to be followed, is an abomination to labour parties elsewhere. The NDP in Canada and Göran Persson, Blair’s opposite number as head of Sweden’s Social Democratic Party, for example, see competition as the beginning of the end for public health care. Sympathy at Number Ten Downing Street turns to disgust at Social Democratic headquarters in Sweden.