The NHS needs its Reformation

5 July 2008

The Spectator on reforming the NHS

The principle of universal, state-funded healthcare remains more or less sacrosanct. It does not follow that the state should be the monopoly-provider. Rightly, if belatedly, the government has experimented with making the NHS a buyer of private services. Unfortunately, not all these experiments have been a success, often because of bureaucratic ineptitude or cultural hostility towards the private sector within the NHS: private companies offering hernia treatments, for example, have been given contracts ensuring they were paid no matter how few patients chose their services. And why is that? All too frequently because GPs have been reluctant to make referrals to private treatment centres.

Lord Darzi now proposes that hospitals be penalised financially for failing their patients. Fine in theory, but we know what happens in practice when public bodies are fined for transgressions: the taxpayer merely ends up paying the fine. More promising is a proposal to give patients an individual budget for their treatment — which they can spend in different ways. For the first time, then, NHS patients will be able to appreciate the real cost of their treatment — and perhaps be disabused of the delusion that state services are ‘free’. As the state of the public finances deteriorates and taxpayers feel the pinch, it is more important than ever that the public debate about tax-and-spend rise above its present infantilised level. Voters and politicians need to hold a mature dialogue about value for money and the proper limits of public expenditure: this dialogue has been scandalously postponed by New Labour’s pretence that its so-called ‘investment’ in the public services has been a ‘gift’ from government to people, rather than a drain on the public’s own resources.