Feature

One year to save the NHS—what would you do?

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39101.713704.47 (Published 25 January 2007) Cite this as: BMJ 2007;334:180
  1. Zosia Kmietowicz, freelance journalist
  1. 1London
  1. zosia{at}blueyonder.co.uk

    BMA chairman James Johnson kicked off 2007 by predicting the NHS had one year to dig itself out of the financial hole in which it found itself wallowing after a decade of reforms and five years of “unprecedented funding.” Zosia Kmietowicz asks a selection of observers where they would start shovelling

    Allyson Pollock, head of the Centre for International Public Health Policy, University of Edinburgh

    The chaos currently engulfing the NHS is due entirely to its “marketisation” by the government and the transfer of up to 50% of public money to the private sector—through contracts for the private finance initiative (PFI); independent sector treatment centres; GP services; IT and other services; billing, invoicing and marketing, and use of management consultants, says Professor Pollock.

    Increasingly, government has given away control of resource allocation and more and more of the NHS's scarce funds are flowing into the pockets of shareholders, bankers, management consultants, and for-profit providers—away from the service. Nothing but a complete reversal of government policy will save the NHS.

    “What is needed to save the NHS is a total abolition of the market and market mechanisms like payment by results, foundation trusts, and commissioning within healthcare, and the abolition of all contracts with private providers, including the compulsory repurchase of PFI hospitals,” says Professor Pollock.

    Giving private providers a foothold in the NHS has allowed them to cherry pick treatments, services, and patients. The result has been to destabilise NHS services, leading to closures.

    Professor Pollock advocates a return to the founding principles of the NHS—universal comprehensive and equitable free health care for all, delivered through a system of risk pooling. She recognises that certain weaknesses in the old NHS, such as public accountability, planning, and integration of services, would need to be strengthened.

    “The NHS was designed to promote equity and integration. In contrast, the market which the government has introduced segments the …

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