On the other hand, if Conservatives are serious about ending postcode lotteries and ensuring equity of provision across different places, they should admit that this would place significant limits on how far local choices can be allowed to result in any differences on anything that matters.
That latter anti-local variation and pro-equity view appears to be the view of Tory frontbencher Grant Shapps, who is energetically touring the broadcast studios to promote his report on the postcode lottery in IVF treatment.
IVF is just too important an issue for different provision. Shapps even turns on his italicisation to point out it is a National Health Service, not a local one (though he does "not necessarily advocate" equitable provision either, perhaps because calling for more spending and spending cuts is another slightly tricky circle to square).
While not necessarily advocating that local Trusts offer the full NICE-recommended treatment, some degree of national, or even regional, standardisation would be fairest for all concerned, even if that means an effective tightening of the criteria in some areas. The continuation of this lottery means that couples are going so far as considering moving to areas in which their dreams of having a baby can be realised. Clearly that is an unfair situation for what should be a national health service.
So Shapps' report follows exactly the pattern observed by Matthew Parris, on this subject three years ago in The Times. Localism is all important - as long as it does not apply to anything that matters.
Post- code lotteries are bad — I think we’re all agreed on that. Which is curious. Because local choice is good. Most people seem to be agreed on that too. Odd, because if local choice makes a difference, you’ll get a postcode lottery.
... The argument for localism is disgracefully mushy; we should be more rigorous about what localism means ...
Whither, then, “local choice”? We English are hugely in favour of it of course, except when it makes a difference ... It is hard to avoid the conclusion that we think no citizen should be placed at a disadvantage by his address; from which, I’m afraid, flows the conclusion that no citizen should be placed at an advantage by his address; from which flows very limited scope indeed for local public bodies to make any difference at all. We are relaxed only about matters of branding, “local pride”, and control of the quaint or quirky as opposed to the useful functions of public administration.
The political problem which advocates of localism have not addressed is that the public do seem to largely think that the equity argument is trumps. A Fabian/YouGov poll in 2007 presented the options of more local decision-making, even if it led to variations in provision, or the same access to treatment and services nationwide, even if this meant little local choice, and found a margin of seven to one, as The Independent reported.
The YouGov poll also casts doubt on plans being considered by all the main political parties to devolve more decisions about health to a local level. There is deep public concern that this would create a "postcode lottery" within the NHS. More than 80 per cent of respondents said patients throughout Britain should have the same access to treatment and services wherever they lived, with rules decided nationally rather than locally. Only 11 per cent thought the NHS would work better if priorities were decided locally.
This does not rule out a case for more localism. But it is difficult to see how this could proceed without greater clarity about what national standards were guaranteed and what is subject to variation.
That means resisting the temptation to use whichever of two contradictory soundbites sounds most popular at any particular moment and admitting there is a trade-off. We might then have an open and informed debate about how much localism, how much variation, and how many postcode lotteries we want.