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Nick Clegg has split from his coalition partners on the role of the health regulator, Monitor.

Clegg also seems to be having a dig at his coalition partners:”People get confused when one day they hear politicians declare how much they love the NHS and the next they hear people describing themselves as government advisers saying that reform is a huge opportunity for big profits for health care corporations.”

Chartered Society of Physiotherapy Chief Executive Phil Gray claims that the destroy the NHS bill always intended to turn the NHS into a state insurance provider.

Cameron distances himself from his adviser Mark Britnell after remarks about turning the NHS into a “state insurance provider, not a state deliverer” of care.

Conservative election poster 2010

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

Clegg: NHS regulator must work on co-operation not competition | News

Nick Clegg today demanded a concession in the NHS reforms by saying that an official regulator should promote co-operation rather than competition between health providers.

The Deputy Prime Minister’s intervention piqued some supporters of Health Secretary Andrew Lansley, who said his plans had always been focused on “quality” rather than price.

He also criticised David Cameron at a private meeting of Liberal Democrat MPs for declaring his “love for the NHS” while taking advice from people talking up the potential for private profits. Mr Cameron was said to be relaxed at the comments made by his Liberal Democrat deputy.

Mr Lansley appeared willing to give ground for the sake of the Coalition, saying: “This is not Henry V on St Crispin’s Day – a one man on horseback approach.” Under the NHS plans, the independent regulator will get a new role as an “economic regulator”. Mr Clegg said there should be a duty to promote collaboration, which might ease pressure on struggling units.

He also said: “People get confused when one day they hear politicians declare how much they love the NHS and the next they hear people describing themselves as government advisers saying that reform is a huge opportunity for big profits for health care corporations.”

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Nick Clegg: NHS regulation re-think just the beginning – Channel 4 News

Nick Clegg is expected to propose further amendments to the Health Bill over the next few weeks as he attempts to appease his party over the scale and pace of the reforms, writes Victoria Macdonald.

On Tuesday night, the Deputy Prime Minister presented a page-long document to the weekly meeting of his parliamentary party in which he singled out the role of Monitor, the NHS regulator, as the area of the Bill needing the most substantial change.

The document, which was later leaked, suggests removing all references to Monitor being an economic regulator.

“Instead of having a duty to promote competition, Monitor’s main duty should be explicitly to protect and promote the interests of patients,” Nick Clegg wrote.

He said the decision to establish it as an economic regulator was clearly a misjudgment and that the NHS could not be treated as if it were just a utility “like electricity or telephones”.

But his party has tabled more than 21 substantial amendments to the Bill and while Mr Clegg has picked out one of the key elements, which goes to the heart of the legislation, Lib Dem insiders say they expect him to deal with issues such as accountability of the commissioning boards, and conflicts of interest where GPs buying care for patients also have financial interests in companies providing treatments.

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Threat to NHS made clear | The Chartered Society of Physiotherapy

CSP chief executive Phil Gray argues that the government’s NHS reform plans always intended to turn the NHS into a state insurance provider, not a state deliverer.

Writing in a letter to the Guardian, published today, Mr Gray says health secretary Andrew Lansley made clear his objectives in his white paper and the subsequent Health and Social Care Bill.

Mr Gray was writing in response to David Cameron’s speech on Monday, setting out the case for the NHS reforms.

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David Cameron ‘had never heard’ of adviser who warned on NHS reforms | Politics | guardian.co.uk

David Cameron has distanced himself from Mark Britnell, a member of the “kitchen cabinet” advising him on health, after he said the government’s reforms would transform the NHS into a “state insurance provider, not a state deliverer” of care.

Cameron said he had never heard of Britnell before the weekend, despite the fact that the adviser – the head of health at accountancy giant KPMG – was invited to join a group of senior health policy experts in Downing Street earlier this month. The “kitchen cabinet”, which includes former NHS executives and the former Department of Health permanent secretary Lord Crisp, was assembled by Cameron’s special adviser on health, Paul Bate.

“He [Britnell] is not my adviser,” Cameron told MPs, insisting he had “never heard about this person in my life” before it emerged on Sunday that Britnell told a conference of executives from the private sector last year that future reforms would show “no mercy” to the NHS.

Britnell also told the conference, held in New York, that the reforms would offer a “big opportunity” to the for-profit sector and suggested the NHS could be improved by charging patients.

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NHS news is dominated by opposition to the Health and Social Care Bill, the bill to destroy the NHS.

Andrew Lansley has just finished presenting a speech to the King’s Fund. NHS reforms live blog – Andrew Lansley speech live | Society | guardian.co.uk

There is disagreement between coalition partners David Cameron and Nick Clegg over the role of Monitor.

Conservative election poster 2010

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

Cameron’s NHS reorganisation likely to widen health funding gap | Left Foot Forward

David Cameron, in a speech at Ealing Hospital yesterday, affirmed his support for Andrew Lansley’s controversial NHS shake up.

In an attempt to shore up support for his government’s ailing NHS reforms David Cameron’s speech sought to explain why change is important for the future of the NHS. What followed, however, were not the words of a man who had taken “time to pause, listen and reflect”. Instead Mr Cameron’s speech neglected to tell the whole story and was almost devoid of any mention of the key issue, competition.

The key plank of Mr Cameron’s address was that his changes were needed in order to save money in the future. He said:

“If we stay as we are, the NHS will need £130 billion a year by 2015 – meaning a potential funding gap of £20bn. The question is, what are we going to do about that.”

He may be asking the right question but he is far from providing the right answer. The truth is that Mr. Cameron’s perilous NHS reforms are going to divert much needed attention away from the key challenge of finding the £15-20bn savings it has been asked for. The King’s Fund rightly points out that:

“Finding the £20 billion in efficiency savings needed to maintain services must be the overriding priority, so the very real risk that the speed and scale of the reforms could destabilise the NHS and undermine care must be actively managed.”

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NHS, CIO, Conservatives, GP, GP Consortia, Andrew Lansley, Minister for Health, healthcare, IT, Pm, Prime Minister, david Cameron, Tory, primary care trust, deficit, redundancy, – CIO UK Magazine

A CIO at one of Britain’s leading NHS trusts has revealed to me the very worrying truth behind the shake-up of the National Health Service that the Conservative Party led government is trying to push through.

If the GP consortia led policy comes into force patient data will be placed at great risk and the likely savings to the national budget are unlikely, in fact tax payers will pay more into the health system for no return.

The leading healthcare CIO described to me the effects that the policy being driven by the Minister for Health Andrew Lansley.

Putting the onus of healthcare funding and decision making onto GPs is, according to this CIO, in effect placing a corner shop sized business in charge of an enterprise as large as a supermarket. The two do not compare, the only similarity is that they are both in the same vertical sector. The infrastructure of best practice and business processes will be discarded.

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Cameron health ‘reforms’ are mess|21May11|Socialist Worker

Tory plans to “reform” the NHS out of existence are taking a battering as public anger continues to grow.

Now even the leading doctor brought in to review the proposals has declared the plans “unworkable”.

Professor Steve Field warned last week that forcing hospitals to compete could “destroy essential services”.

A desperate David Cameron was forced to respond by visiting a London hospital to pledge his family’s “love for the NHS”.

But beneath his honeyed words were barbed warnings that the Tories are in no mood to retreat. “It is because I love the NHS so much that I want to change it,” he said.

But Cameron said he remains committed to more privatisation and more competition in the NHS.

Private healthcare companies are already rubbing their hands together at the prospect of grabbing our cash.

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NHS reforms live blog – Andrew Lansley speech live | Society | guardian.co.uk

10.14am: The health secretary gets polite applause as he finishes speaking.

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BBC News – Nick Clegg to oppose NHS competition regulator

Nick Clegg will oppose the idea of a regulator promoting competition in the health service in England, a key part of planned NHS reforms.

It places the deputy PM in opposition to Health Secretary Andrew Lansley who wants more competition to cut prices.

Mr Clegg also criticised David Cameron for declaring his love for the NHS while taking advice from people talking up the potential for private profits.

Labour said Mr Clegg was only interested in saving his party.

BBC deputy political editor James Landale said Mr Clegg’s intervention, in a meeting with Lib Dem MPs and peers, marked an escalation in negotiations with his Conservative partners over the Health and Social Care Bill which is currently on hold.

It will also be seen as a rebuff to the prime minister who used his speech on Monday to try to assert his political authority and ownership over the changes being made to the bill.

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Pulse – GPs told to cut hospital use by 15% in a year

Exclusive: GPs are facing demands to deliver unprecedented reductions in hospital activity over the current financial year, with NHS managers setting targets for cuts in admissions of 15% or more by next April, a Pulse investigation reveals.

Primary care organisations are going far further than even the Department of Health had planned, and demanding GPs deliver major cuts in hospital activity in less than half the time set out in the national QIPP programme. GPs warned the plans were unachievable and that there was a risk they could damage patient care.

In November, Pulse revealed Sir John Oldham, DH national clinical lead for quality and productivity, had warned GPs that by the end of 2013/14, they would have to cut unscheduled admissions of patients with long-term conditions by a fifth and help reduce A&E attendance by 10% and length of stay by 25%.

But responses from 120 PCTs and health boards under the Freedom of Information Act show they have earmarked an average 15% reduction in unscheduled hospital admissions in patients with long-term conditions by April 2012 alone. They are also targeting average reductions of 31% in A&E attendance and 26% in length of stay by the end of this financial year.

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Nick Clegg threatens to veto health reforms over role of NHS regulator | Politics | guardian.co.uk

Nick Clegg, the deputy prime minister, has set himself on a collision course with the health secretary, Andrew Lansley, by signalling his determination to veto a key plank of the government’s controversial NHS reforms.

Clegg has singled out the role of Monitor, the NHS regulator, as the area of the embattled NHS bill that needs the “most substantial changes” and has said descriptions of the body as an economic regulator should be removed on the grounds that the NHS cannot be regulated as if it were just a utility “like electricity or telephones”. [or trains]

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Coalition in ‘Grand Canyon’ split over future of the NHS ‘reforms’

A chasm as deep as the Grand Canyon has emerged between the coalition allies over the role of Monitor, which will regulate competition in the ‘reformed’ NHS.

Unite, the largest union in the country, said today (Wednesday 18 May) that Liberal Democrat leader Nick Clegg’s assertion that Monitor should focus on collaboration rather than fostering competition in the NHS was a direct challenge to David Cameron.

A central tenet of the Health and Social Care bill, currently before parliament, is that a beefed-up Monitor would be the engine to encourage competition and open the door for private healthcare companies to gobble up and ‘cherry pick’ lucrative NHS contracts.

Unite’s national officer for health Rachael Maskell said: ”Nick Clegg’s new found assertiveness against the privatisation of the NHS is to be welcomed – but uncomfortably for the coalition it now exposes a chasm as wide as the Grand Canyon over the fate of the bill in particular and the future of the NHS between the coalition partners.

”David Cameron is being two-faced. On one hand, he is engaging in a PR exercise saying how much he loves the NHS, yet the Tory party has been bankrolled by private healthcare companies since he became leader. The NHS is not safe in Tory hands.

”The prime minister is also reportedly being advised by Mark Britnell – former NHS official now working for accountants KPMG – who is alleged to have said that private companies would show ‘no mercy’ to the NHS.

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NHS news is dominated by a speech given by David Cameron yesteday. He claims that the NHS must change but that does not justify the privatisation and withdrawal of services that he proposes.

He mentions a crisis of funding. 38 Degrees and UK Uncut are clearly showing how to resolve that issue – by combating tax avoidance by rich tax avoiding Capitalists.

17.05.11: Steve Bell on David Cameron's NHS reforms speech
17.05.11: Steve Bell on David Cameron's NHS reforms speech

He engages in “It’s because I love the NHS so much that I want to change it.” emotionality which attracts many comments. I wonder if Craig Oliver was drunk when he came up with that one.

Cameron repeatedly claims that the NHS is safe in his hands BUT the Health and Social Care Bill does away with the government providing a comprehensive health service

and

it has received near total opposition from healthcare professionals. Cameron claims to be willing to listen to doctors and nurses BUT they are calling for the bill to be abandoned.

Many groups and individuals respond to Cameron’s speech.

Conservative election poster 2010

A few recent news articles concerning the UK’s Conservative and Liberal-Democrat coalition government – the ConDem’s – brutal attack on the National Health Service.

My love for the NHS is why I want change… » Hospital Dr

(Text of Cameron’s speech)

PM has still not made case for NHS reforms | News

David Cameron’s speech today on NHS reform has one familiar element: the extent of his personal attachment to the health service.

“It is because I love the NHS so much that I want to change it,” he says. That is an argument familiar from the election campaign, when Mr Cameron emphasised that the NHS was safe in his hands precisely because he had personal experience of its excellence during the tragic illness of his late son, Ivan. Indeed, it underlay the Tories’ commitment not only to exempt health from spending cuts, but to increase its funding.

Few doubt the NHS needs reform and that spending at present levels is unsustainable given the demands of an ageing population and the expansion in expensive new treatments. But accepting the need for reform is not the same thing as welcoming the Government’s health bill. This is a complicated set of proposals in one piece of legislation, which gives GPs more control over spending and commissioning services and at the same time seeks to take out layers of bureaucracy and increase competition. Many people, including health professionals, who would happily give GPs a greater say in the service, baulk at the extension of commercial competition. And Mr Cameron’s decision to “pause” the reforms – but not, as he says today, to stop them – is a measure of the public disquiet about the Bill and its implications.

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UNISON Press | Press Releases Front Page

Commenting on David Cameron’s speech on the Health and Social Care Bill, at Ealing Hospital, in London, today (16 May), Christina McAnea, Head of Health at UNISON, which represents more than 450,000 health workers, said:

“David Cameron is taking the ‘national’ out of the health service and turning it into a fragmented, money-spinning operation.

“The Prime Minister is using extreme examples to paint an untrue picture. He admits the NHS is providing the best service it has ever done, with reports saying it is the most efficient and equitable health system.

“Cameron’s call to crack down on waste in the NHS is a smokescreen for a move to a wholesale market, which opens the NHS up to privatisation. The real waste is the time spent on the fatally flawed reforms, which will force NHS patients to the back of a very long queue.

“He talks about having more choice and protecting budgets, but health workers are seeing their jobs axed and wards, services and even entire hospitals lost without any arrangements to protect continuity of patient care.

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Unite questions how Cameron’s ‘substantive’ changes to NHS bill are going to happen

David Cameron’s pledge to ensure ‘substantive’ changes to the NHS ‘reform’ bill should be probed to discover what he actually means, Unite, the largest union in the country, said today (Monday 16 May).

Unite said that the deeply flawed Health and Social Care bill should be scrapped and a rtoyal commission set-up to investigate the future of the NHS.

Unite pointed out the discrepancy between the prime minister’s ‘vision’ and the fact that tens of thousands of NHS jobs had been or were going to be lost in the near future. Wards are already closing, waiting lists growing and services being axed or reduced.

Unite national officer for health, Rachael Maskell, said: ”David Cameron in his speech today was long on rhetoric, but short of specifics. This was a PR exercise in verbal gymnastics due to the political pressures he is under, especially from his Liberal Democrat allies.

”David Cameron wants it both ways with the Health and Social Care bill. He said today there will be no privatisation, no ‘cherry picking’ of services by private companies and no up-front costs for care, but we question how the prime minister’s ‘substantive’ changes are going to be incorporated into the legislation.

”The bill is so flawed that it should be scrapped. The whole bill is designed on the premise of Monitor’s role as an economic regulator and the concept of ‘any willing provider’ i.e. private companies. If the prime minister is serious about these changes, it will mean a new bill.

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Macmillan Responds To The Prime Minister’s Speech On NHS Reform, UK

Responding to David Cameron’s speech on NHS reform today, Mike Hobday, Head of Policy of Macmillan Cancer Support, said:

“We welcome the Prime Minister’s reassurance that the relevant healthcare professionals will be involved in key decision-making about the commissioning of NHS care and the commitment that patients will receive high-quality and coordinated care, rather than the NHS being subject to an unbridled free market. This is a key safeguard to ensure that care for cancer patients does not suffer under the proposed NHS reforms.

“Cancer is a set of highly complex diseases and GPs tell us that they will need specialist help to commission cancer services. This is why it is vital that cancer networks should continue to be used to inform decision making about the commissioning of cancer services, and why the Government must commit to fund them at least until GP consortia are up and running in 2014.

“We hope the ‘listening exercise’ results in a long-term commitment to clinical networks, and are encouraged by the David Cameron’s comments today that this will be the case.”

BMA Comment On Prime Minister’s Speech On NHS, UK

Commenting on the Prime Minister’s speech on NHS reform in England today (Monday 16 May, 2011), Dr Hamish Meldrum, Chairman of Council at the BMA, said:

“We agree with the Prime Minister that the NHS needs to change. There needs to be greater integration, greater efficiency, and more emphasis on prevention. However, the Health Bill as it is currently written would make these improvements far harder to achieve, leading to a more fragmented health service, with many hospitals at risk of closure. Whilst we welcome his commitment to listening to staff and to taking them with him, most doctors will not feel able to support this Bill unless it is radically amended.”

The Prime Minister also highlighted the fact that alcohol misuse and obesity place significant burdens on the NHS. Dr Meldrum added:

“Unfortunately the government has often ignored the advice of health organisations on how to tackle alcohol misuse and obesity, preferring to listen to and rely on the views of industries which have a vested interest in selling unhealthy products“.

Labour – Cameron’s Reforms Will Leave NHS Fragmented, Taking it Backwards – UK Politics – News on News

John Healey MP, Labour’s Shadow Health Secretary, has hit out at David Cameron’s plans for NHS reform, saying they will leave the service fragmented and take it backwards.

Labour has also released a document on the lack of coherence in the Tory-led Government’s plans and showing the level of concern and opposition to them throughout the NHS.

John Healey said:

“This is the Prime Minister’s third launch of his NHS plans. He’s made his ‘I love the NHS’ speech before but today he said nothing to clear up the confusion and chaos around his ideological, top-down reorganisation. He made the case for change in the NHS, but not for his change.

“David Cameron’s plans will fragment the NHS, with a free market free for all undermining the quality, integration and public accountability of NHS services. As even the Tory-led Health Select Committee has said, the legislation as it stands will make better services and better value for money harder not easier to achieve. It will take the NHS backwards.

“David Cameron talks of his love for the NHS, but he has broken his promise to protect the NHS. If he really wants an NHS with no privatisation, no new charges for patient services and no competition for its own sake, he must make fundamental changes to his NHS plans because his Health Bill allows exactly this.”

Ignore his denials: Cameron, like Blair, wants to turn ‘NHS’ into a kitemark | George Monbiot | Comment is free | The Guardian

The difference between David Cameron and Tony Blair is that Blair was better at disguising his intentions. He would never have announced, for example, the sale of public forests. Instead he might have promised “a world-class forest estate” in which “walker-led beacon-foundation woodlands” would be managed through “partnerships with a plurality of recreational providers”. Ten years later we would discover that our forests had mysteriously fallen into the hands of timber companies, and were being felled in the name of customer choice.

Nor would he have done anything as stupid as this government’s attempt to transform the NHS in one bill. Cameron sought to dig himself out of his hole on Monday, but too late. His claim that “there will be no privatisation … no cherry-picking from private providers” reminds us that privatisation and cherry-picking are the likely outcomes of his bill. Blair would have allowed private interests to keep spreading through the health service as slowly and quietly as dry rot. In their book The Plot Against the NHS, Colin Leys and Stewart Player show that Cameron’s health and social care bill consolidates a plan that has been fermenting for many years.

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The Plot Against the NHS #1

The Plot Against the NHS #2

 

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The plot against the NHS
The plot against the NHS

Selected excerpts from ‘The Plot Against the NHS’ by Colin Leys and Stewart Player. Chapter One is available here. I highly recommend this book available from Merlin Press for £10.

p.148~154 References in the original.

Within the BMA a strong challenge emerged to the leadership’s position of ‘critical engagement’ with the government’s plans, and a demand for outright opposition. The development of serious opposition from a large part of the medical profession, and especially from GPs , was significant, because Lansley constantly claimed to have their support.

The false case for the Health and Social Care Bill

The government’s claim that the NHS was in urgent need of further fundamental reform was also becoming more and more obviously false. During the previous ten years, while the NHS was being covertly marketized, the Labour government had raised NHS funding rapidly towards the average level of spending of the other major countries of Western Europe. Spending on the NHS still remained significantly below that of the richer EU nations, and a significant portion of the new funding was absorbed by the cost of market creation. But the extra cash also produced some important improvements. Staff levels were improved, waiting times for elective care were sharply reduced, facilities were renovated or replaced.

This was reflected in the high marks given to the NHS in the Commonwealth Fund report cited in chapter 1. And by 2010 the particular charge constantly made by the marketizers, that England lagged behing European countries in the survival rates for major killer illnesses, was ceasing to be true. Lansley repeatedly declared that a wholesale restructuring of the NHS was ‘a necessity, not an option’, and David Cameron asserted that ‘pretending that there is some “easy option” of sticking with the status quo… is a complete fiction’. But in January 2011, coinciding with the publication of the Health and Social Care Bill, a paper by the King’s Fund economist John Appleby, published in the BMJ, showed tha t the marketizers’ charge was unfounded. It turned out to rest partly on the use of European data that were not comparable with the English data (and in some cases highly unreliable), and partly on selecting static data instead of trends over time. For several of the conditions usually cited English survival rates have in fact been improving so fast over the last 30 years that if the trends continue they will overtake
European rates by 2012.

The real choice

The choice is not between change and no change. It is between handing over a public service to be developed by private enterprise in the interests of shareholders, and ensuring that it develops in the interests of the public – and as the public sees those interests, not as politicians declare them to be. To maintain that there is no capacity for improvement within public provision is empty rhetoric. What evidence is there that public servcies are incapable of change and improvement (provided they are not undermined by financial starvation or market-driven disorganization)?

Around the world there are various examples of excellent public and publicly-provided health services, and all of them need to be studied for ways to improve the NHS in England – and beginning with an examination of those that are developing within the UK itself. The national media largely ignore what occurs across our nearest borders, but what is happening there, and especially in Scotland and Wales, raise crucially important questions about the future now being charted for the NHS in England.

Looking at Scotland

Even before devolution health ministers in Westminster had been too aware of Scottish sentiment to risk pushing the internal market very far there, and the Labour-Liberal Democrat coalition governments that held office in Scotland after devolution, from 1999 to 2007, recognised that voters would not support them if they followed England’s path to a healthcare market. Scotland’s Area Health Boards remained in place, foundation trust status was not introduced, nor was payment by results. The PFI was used for three Scottish hospital-building schemes, and one Independent Sector Treatment Centre was opened at Strathco in Angus. But these measures provoked intense controversy and in 2003, responding to pressure from both doctors and the public, the coalition government ended the purchaser-provider split, restoring direct administration to the NHS in Scotland and decisively closing off the market option. Also in response to public opinion, in 2002 the Scottish Labour-Lib Dem coalition made personal care for the elderly free, instead of means-tested as in England.

The 2007 elections, however, led to the formation of a minority SNP government, and yet further departures from the market-driven policy that was being pursued in England. In 2008 hospital car parking charges – a significant deterrant for families – were abolished, except at PFI hospitals, where legal reasons prevented it; and in 2010 plans were announced to abolish prescription charges from 2011. No further PFI schemes have been undertaken. Glasgow’s biggest acute hospital is being built with public funds, the ISTC at Stracathro was taken into public ownership, and plans to outsource the management of a health centre in Lanarkshire to a private company were dropped. Out-of-hours care is publicly provided.

Perhaps most significant of all for the future, in 2009 elections were introduced for the majority of the members of Scotland’s Health Boards, beginning with two pilot schemes to be evaluated after four years. This means that in addition to professional medical judgement democratic representation, rather than individual ‘patient choice’, could become a significant element in determining the direction of future change.

In face of all this the marketizers inevitably portrey Scotland’s NHS as a failure, with the usual misuse of statistics to support their claim. For example they routinely state that Scotland’s waiting times are worse than England’s, because no element of competition has been introduced into Scotland’s. In fact an analysis of newly-consolidated data concludes that since 2005 waiting times have fallen faster in Scotland than in England. In each year since then Scotland has actually had either the second shortest or (more often) the shortest waiting times of the four nations in the UK. And over the ten years from 1999 to 2008 Scotland’s mortality rates for all causes of death declined almost exactly as fast as England’s. As Dr Matthew Dunnigan, the author of the waiting times analysis, says, the objective comparison of English health statistics with those for the three devolved nations is now a very important task.

Looking at Wales

The story in Wales has many similarities to Scotland’s. For the first eight years following devolution a Labour minority government was in office, only giving way to a Labour-Plaid Cymru coalition in 2007. But as in Scotland, even the initial Labour-led Welsh Assembly Government did not dare follow the English path. The purchaser-provider split remained, but Wales did not adopt foundation trusts or payment by results. Development remained based on collaboration and planning, rather than on a market system with legally enforcable contracts and all the tensions and extra administrative costs involved.

And after 2007, under the Labour-Plaid coalition, the purchaser-provider split was dropped. In 2009 a major reform resulted in the formation of just seven integrated Local Health Boards to plan and operate the NHS in Wales. These are very like the Area Health Boards in Scotland, but also have overall responsibility for all aspects of health, including public health, with a strong emphasis on linking health and social care.

The Local Health Boards in Wales are not elected but they must have members representing local primary care, community care, public health, local government and voluntary organizations, as well as lay members. In one Local Health Board (Powys) the purchaser-provider split was abolished earlier and the Board was integrated with primary care and community health service providers. Other Boards are set to follow suit – exactly the opposite direction of change from that taken in England, where even community health services have been forced into the marketplace.

Wales also declined to use the PFI for hospital-building, led the way (in 2007) in abolishing prescription charges, abolished hospital parking charges, and dealt with the vexed issue of means-tested personal care for the elderly by widening the definition of what is considered nursing care (and therefore free), and by setting a flat-rate contribution to the cost of personal care throughout the whole country.

Considerations for England

We need to ask ourselves why Scotland and Wales opted to keep the NHS as a public service, and even extend the principle of free acess. Longstanding Scottish and Welsh cultural traditions are certainly important, especially a deeply-embedded commitment to social democracy in public life, and in the medical profession, which politicians of all parties have to respect. But another key reason is cost. Next to education health is by far the most important and expensive devolved publis service. Even before the financial crisis politicians of all parties in Scotland and Wales realised that if they followed the English route, and allowed the costs of operating a market to start soaking up ten per cent or more of the health budget, health services would be liable to deteriorate, with dire political consequences for themselves.

They know that the public spending cuts imposed by the government in Westminster will hit Scottish and Welsh health services. But they also know that the effects will be smaller that they would have been had they opted for a market, and that whatever they have to do will have a legitimate foundation in public opinion, which remains at the base of decison-making about the NHS in both countries. And when the crisis has passed they will still have a public health service, not a three-tiered healthcare market and a low-risk playground for healthcare corporations and ‘doctorpreneurs’.

Scotland and Wales don’t exhaust the alternatives for the future in England. Other good models of publically-provided health services exist and deserve study. But the successful evolution of the NHS in the rest of the UK shows that Cameron’s assertion that ‘we can’t afford not to modernise’ – meaning that we have no alternative but to accept the abolition of the NHS as a public service – is pure bluster. It has no foundation in evidence and serves no interest except that of the private health industry. In the parts of the UK that the plot against the NHS couldn’t reach, people see through it. They know that good health care for all means excluding profit-making, and have shown that with sufficient public backing that principle can prevail. We need to insist that in England too the NHS is not for selling.

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