Controversial Heath Reform
Concerning the withdrawal of local facilities, the coalition government's Health and Social Care Bill 2010-11 heralds the most controversial reform in the history of the NHS in England. The government plans to replace the NHS system of public funding and mainly public provision and public administration with a competitive market of corporate providers in which government finances but does not provide healthcare. Primary care trusts and strategic health authorities are to be abolished and replaced by general practice commissioning consortiums, which all practices must join. As incorporated bodies, consortiums will not be directly controlled by the secretary of state for health and may enter into commercial contracts with any willing provider for all health services and will set terms and conditions of staff. They will have extraordinary discretionary powers to define entitlement to NHS provision and charge patients.
Hospitals under budget pressure have faced many dire decisions. Until recently the private sector played an unimportant part in England's health services. Well over 95% of interactions between a patient and doctor took place in the public sector. Private general practitioners existed only in isolated pockets. Emergency hospital care was all in the public sector, and the private sector was concerned mainly with elective surgery. Patients went private simply to jump queues. Now suddenly the government is looking to the private sector to save the National Health Service (NHS), causing many to worry that the NHS is to follow airlines, telecommunications and railways into the private sector. It might soon be in England that the financing and regulation of the health service remains with the government but that the provision and management of the service lies increasingly with the private sector. In under a decade, the private sector has turned from being a pariah to a saviour.
Tough Democratic choices include reducing the deficit. This requires the size and role of government to be curbed. Theexpanding size and role of the government has lead to unsustainable levels of public spending,which not only has an associated fiscal cost but weakens individual ambition and enterprise.The only way to put the public finances on to a sustainable basis will be to limit the ambitionsof the state. The task of deficit reduction needs a conception of government that is both limitedand reformed. This could include:A defined core of publicly-funded NHS services, in common with other countries, a later retirement age that is tied to longevity, the role of government to change from being both funder and manager of services to more often being a funder only, reforms that would provide budgets directly to individual consumers, this would make services accountable to their users, a change in the terms and conditions of public sector workers.