NHS is headed for the worst of all worlds

The National Health Service (NHS) is a rambling nationalised industry in which much is spent on obsolescent services and the scarce time of experienced professionals is used poorly, says Nick Bosanquet, professor of health policy at Imperial College and consultant director of the independent think tank Reform.

But there are several factors that could bring about real changes, says Bosanquet, including:

  • An acceptance that the public funding constraint is real, strong and permanent; the NHS should be able to provide a superb service for 10 per cent of gross domestic product (GDP) – Scandinavia, Spain and Australia do it for less.

  • A clear economic constitution must be set for primary care trusts (PCTs) so that their main duty is to get value; too much money goes out to support obsolescent services.


  • Services should be identified where the NHS is not, realistically, going to provide access, and deregulation should be used to encourage the growth of new providers and new markets.

  • Central planning of pay and manpower should be ended; pay and work roles should be decided locally by trusts and general practitioner (GP) practices, with freedom to reward service rather than simply administer a pay scale.

    Perhaps most importantly, competition and choice must become key themes. Indeed, most of the NHS's successes have come from incentives to reform, not from extra funding, says Bosanquet:

  • Patient choice led to a remarkable fall in waiting times for heart surgery; these have stayed down.

  • Treatment for cataracts is immediately available as a result of competition from independent centres.

  • Foundation trusts are showing the way in improving value and developing services.

    Source: Nick Bosanquet, NHS is headed for the worst of all worlds, Telegraph, September 12, 2007.

    For text: http://www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2007/09/12/do1206.xml

    For more on Health Issues: http://www.ncpa.org/sub/dpd/index.php?Article_Category=16

    FMF Policy Bulletin/ 18 September 2007
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