Adam Smith Institute

The Institute of Economic Affairs has just launched a great new book by the Director of Nurses for Reform: ‘Sixty Years On: Who Cares for the NHS?’

Researched and written by senior nurse and health economist, Dr. Helen Evans, the study lays out the private opinions of the country’s top 100 health opinion formers. According to the author:

This groundbreaking new study shows that although politicians do not feel confident in proposing radical new models of healthcare, elite opinion in the media, in political circles, in academia and in policy think tanks has fallen out of love with the idea of a centrally planned health service providing and financed by government.

Indeed. The results this work presents show that the world has moved on in profound and important ways since the late 1940s. Crucially it shows that on the eve of its sixtieth anniversary, the NHS is no longer a much loved British institution. For the political class, as for the rest of us, it has become an embarrassment and a national disgrace.

The government have announced a review of their policy of denying NHS services to patients who top up their care with private treatment. The rule has meant that cancer patients wishing to pay privately for a more effective drug not offered by the NHS have ended up having to foot the bill for all their treatment.

In the past, the Department of Health has maintained that, "Co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS." In other words, the health service's Soviet-era ideology was regarded as more important than the health of its patients.

Obviously, that this sickening policy is under review is welcome. But I really wonder what there is to think about. As I've said in a previous blog, the prohibition of co-payments is immoral, incoherent and quite possible illegal.

It's immoral because the government have no right to deny people services they have already paid for (through the tax system) just because they want to pay privately for some additional services that are too expensive to be offered on the NHS. Who is the Health Secretary to tell people they can't have a potentially life-saving drug even if they're prepared to pay for it themselves?

It's incoherent because people are already allowed to pay extra for private rooms, televisions and other non-clinical benefits in NHS hospitals. Why shouldn't they be allowed to pay extra for newer medicines?

As for illegal – well, the NHS has a legal duty to provide 'reasonably required' care unless there is some legitimate reason not to do so. Limited resources are a legitimate reason, but if you are prepared to pay the extra money yourself, then it's hard to see what acceptable grounds the NHS could have for refusing to allow the treatment.

It is high time the government moved beyond thinking that 'fairness' means preventing anyone from accessing better care. And they shouldn't need a lengthy review process to tell them that.

A million people in the UK have petitioned Downing Street against polyclinics – the 'super-surgeries' that will absorb or replace many existing family doctor practices – the so-called general practitioners or GPs.That's almost as many who petitioned against road congestion charging. Given that they are both so unpopular, can we conclude that these ideas are both pretty daft?

Well, road charging is a sensible idea. It allows you to charge on the basis of use, and on the basis of the costs that road users cause to others when they all decide to come into town at the busiest times. People reject it because they know politicians too well: they fear it will be an extra charge, not one which replaces existing motoring taxes.

Polyclinics aren't a bad idea either. There's strong evidence that indiividual GP surgeries have poorer medical outcomes than group practices, where doctors can share administrative and nursing backup, can share patient loads, and can specialize to a certain extent. Making them even bigger, allowing diagnostics and even some surgical procedures to be done at the same site – saving patients from going back and forth to hospital – seems an obvious extension of this.

But now patients are saying they rather like their local GPs. They like to see the same doctor every time. They like the fact that their doctor is near to where they live. And NHS experts too worry that they are just going to duplicate what hospitals already do.

Again, it's the fact that the existing setup is state-run. That means there is no market information to tell the provider (the government) what people actually want. I suspect that in a market healthcare system, people would rather like small-scale medical services near where they live. Or maybe better, something near their work that was open on their way in and out, and at lunchtime. And probably they would like smaller (dare one say 'cottage') hospitals or clinics near where they live, in preference to the huge district hospitals that 1970s state giantism gave us. And they'd like more downline tests, consultations and monitoring, rather than having to turn up in person all the time.

But that's only a guess. Without the preference information that we get from having a market, we can't know. Which means that whatever the government does, it's bound to get wrong, and upset a lot of people in the process.