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NHS independence is no laughing matter
- Joannis E Vamvakopoulos (1 June 2007)
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Not only but also...
- Steven Ford (7 June 2007)
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NHS Independence
- Heather M Gage, Alan R Bird, Lesley Storey (3 July 2007)
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Joannis E Vamvakopoulos, Medical student University of Birmingham Medical School, Edgbaston, Birmingham B15 2TT, UK
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In recent days there has been no end to debate around the BMA paper "A Rational Way Forward for the NHS in England", which thrust the issue of political meddling in the NHS into the limelight. Criticism has been directed at what is seen as naive, wishful thinking by doctors and other health professionals. But the need for NHS independence from political control should not be taken lightly. Fans of Monty Python will have noted the uncanny resemblance of Gordon Brown to Terry Jones; let's hope he doesn't turn out to be a joker. Competing interests: None declared |
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Steven Ford, GP Haydon & Allen Valleys Medical Practice
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Sir This was an excellent review. Whence comes this curious delusion, so often rehearsed, that parliament must remain accountable, in some form, for the sums spent on the NHS? If evidence based government were in effect then it would be deemed essential that parliamentarians and civil servants be completely taken out of the equation. Since the inception of the NHS every government, in any number of ways, has proven itself wholly incompetent in running the NHS. The survival of the NHS requires that it is wholly independent and, furthermore, there remains a rebarbative coterie in the Conservative party, who call themselves the Cornerstone Group, whose avowed intent is the complete annihilation of the NHS. Not only must the NHS be fully independent but it must also be made impervious to erosion by subsequent barbarian assault. Yours sincerely Steven Ford Competing interests: None declared |
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Heather M Gage, Senior Lecturer in Economics University of Surrey, Guildford. GU2 7XH, Alan R Bird, Lesley Storey
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Both Nigel Hawkes’s commentary on NHS Independence1 and Professor Brian Edward’s review of alternative models2 to which Hawkes refers focus mainly on the political ramifications. They do not develop the implications of the various options for sustainable financing, which is an important issue for the future of the NHS. The powers of an NHS Authority could extend to setting and collecting an income-related health levy (tax or premium) replacing part of income tax and national insurance contributions. Separating payment for healthcare and making it transparent in this way would have several advantages: competition between healthcare and other government programmes would be removed, fiscal illusion (the public’s disconnect between a desire for more government expenditure and the associated tax implications) would be reduced, the awareness of consumers about how much they pay for their ‘free’ health care would be increased (which might engender greater cost consciousness), and payment for healthcare would be more progressive (equitable). This suggestion fits well with Edwards’s seventh model in which the NHS “would be defined as an insurance company funded by taxation [that] licenses other competing organisations [GPs, PCTs, insurance companies, trades unions, employers] to commission health care services”1. The innovative aspect of this is that consumers would be able to choose the commissioner of their services. In place of PCT monopolies and a raft of rules and targets, competition for consumers between commissioners would be a natural incentive for quality improvement, efficiency savings and the development of more responsive services. Commissioners would seek these elements from providers through the contracting arrangements they made with them. Whilst Parliament remained responsible for defining core services that commissioners must cover and setting limits on increases in the NHS levy, the Authority’s role would include collecting and publishing performance indicators to inform consumer choice, risk adjustment between commissioners, and managing a buffer fund to cover contingencies. The centralised NHS bureaucracy would be substantially slimmed in this model, and commissioners would face incentives to minimise their administrative costs. The proposal remains concordant with the founding principles of the NHS, has features in common with relatively successful European social insurance schemes, would depoliticise the delivery of health care and has the potential to increase the engagement of consumers. References Hawkes N. Independence Day? BMJ 2007; 334: 1136 -38. Nuffield Trust. An independent NHS: a review of the options. London: Nuffield Trust, 2007 Competing interests: None declared |
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