nhsAs part of its push for transparency in public services, the government has released a “UK health atlas”. Its aim is to show the variations in health spending and outcomes in primary care trusts around the country. The findings show huge disparities in provision. The idea behind this release of information was to encourage patients to put pressure on the lowest performing primary care trusts. It has, however once again highlighted that the NHS suffers from serious disparities in the quality of care provided. This suggests that the system of healthcare provision in this country has to be radically overhauled.

There are huge discrepancies in spending between primary care authorities – for example, there is a fourteen-fold difference between the highest and lowest expenditures on hip replacement surgeries in different authorities. Some health authorities spent two and half times as much on mental health care compared to others. These variations clearly indicate that the postcode lottery of healthcare is still a major problem. The atlas was standardised to take account of various social and patient factors, so variations in spending cannot fully be explained by these elements.

The lack of a price system means that it is impossible to know which trusts are at fault – are some spending too much, or are others spending too little? What is the optimum amount of money to allocate to hip replacements? Giving power over health spending to a bureaucrat means that spending decisions will be made without the necessary information that a price system would convey.

The most important step to improve the NHS is to break its monopoly on the healthcare market. There should be a move towards the state becoming the regulator rather than the manager of these hospitals, and the provider of funds to support patients rather than of services. Because there is no price mechanism, there is currently an enormous amount of bureaucracy in the system, which all too often results in bad performance of services. The lack of competition means that hospitals can underperform without any incentive to improve. Breaking up the NHS would be a big task, but by doing so the government and the charities would see better care for patients.