The NHS Plan: A view from 30,000 feet

Professor Alain Enthoven is one of the world's leading health policy analysts. In this paper for ASI, he reflects gloomily on the prospects for real improvements in NHS delivery unless there are more radical reforms than those politicians are contemplating.

[gview file="http://www.adamsmith.org/sites/default/files/images/uploads/publications/30000feet.pdf"]

Facing the Future

The British appear to face he newly unfolding century with mixed feelings. They think Britain will survive, but may be less influential. It will be closer to the Unites States. They are skeptical about many of the predictions made for scientific advantage, but confident about general advances achieved in living standards and life's opportunities. Broadly speaking they expect better times, unmarred by world wars. They expect the welfare state and most public services to wither and die, replaced for most people by private alternatives. About 3 in 5 of them expect this to happen to the NHS and state welfare, and 2 in 3 expect it of state pensions.

Where the young differ from their elders, they tend to be more optimistic. The notable exception to this is that more of them think a world war is likely. They do not, however, think that the British will regard themselves as Europeans first or expect Britain to lose independence or influence.

[gview file="http://www.adamsmith.org/wp-content/uploads/2015/09/Facing-the-future-.pdf"]

Unitary Medical Regulation

The regulation of clinical practice must focus on the clinical service standards that are delivered to patients, and not on protecting professional self-interest. It must be accepted and trusted as such by the public. We envisage therefore a single regulatory authority that is independent of the healthcare professions. It should be dominated by lay representatives, and perhaps chaired by a lawyer rather than a clinician.

 

[gview file="http://www.adamsmith.org/wp-content/uploads/unitarymedical.pdf"]

Respectable Trade

'Respectable Trade' is a critique of what the author calls the 'dangerous delusions of corporate social responsibility and business ethics'. Should we ask more of our business people than that they conduct their affairs as openly and honestly as anyone else?

 

[gview file="http://www.adamsmith.org/wp-content/uploads/respectable-trade.pdf"]

The Big Turn Off

'The Big Turn Off' analyses the attitudes of young people to government, citizenship and community. It shows that only a small proportion of young people share the government view that citizenship means volunteering to do things, challenging the law if they think it wrong, or being active in the community. They have little time for government, be it local, national or European, thinking it largely irrelevant to their lives.

 

[gview file="http://www.adamsmith.org/wp-content/uploads/big-turn-off.pdf"]

Simpler Taxes: A guide to the simplification of the British tax system

Simpler Taxes is an indictment of the nation's tax system, which imposes huge costs upon the economy. If taxes were simplified, people would realize the huge gap between what they are paying and the services they receive in return. Exploring how globalization and the Internet are making it ever more difficult to levy traditional taxation, Braestrup concludes that governments must, in effect, compete for the loyalty of their citizens with attractive tax regimes. His proposal for Britain is that complex and obscure taxes should be replaced by visible ones which are easy to understand, and whose rates are lower.

Read this report.

Privatizing Access to Justice

Up to now, access to justice has been the privilege of the wealthy and the minority who are sufficiently poor to qualify for civil legal aid. Most other people had no access to civil justice, a factor which has brought the civil justice system into disrepute. The government is presently undertaking a major and long-overdue reform of the civil legal aid system in accordance with the Access to Justice Act 1999. Reforms enacted on 1 April 2000 abolish legal aid for most civil claims. Instead, it is expected that cases will be funded by the conditional fee system - popularly known as "no win, no fee". In this system the lawyer agrees with his client to charge an additional success fee if the claim is successful, but may charge nothing if the claim fails. It is an example of payment by result. These reforms effectively represent the privatisation of access to justice. The civil courts are increasingly accessible to anyone with a meritorious claim.

 

[gview file="http://www.adamsmith.org/wp-content/uploads/justice-briefing.pdf"]

The Road from Inequity

Town traffic causes by far the bulk of the congestion, pollution, accidents, and noise nuisance of driving - all of which cost society seven times what urban motorists pay in taxes. Rural drivers, by contrast, are overcharged three times for their use of the roads. For heavy vehicles in urban areas during peak-hours this discrepancy is even higher, claims the report, which proposes a £15 billion cut in the revenue collected in fuel duty, vehicle taxes and VAT. People driving in towns, however, would pay tolls averaging 5.6p per mile, with charges much higher at peak times and for high-polluting heavy vehicles.

[gview file="http://www.adamsmith.org/wp-content/uploads/road-from-inequity.pdf"]

Response to the CAA

The Adam Smith Institute has told the Civil Aviation Authority that UK airports are over-regulated and under-competitive. This report by former airport director David Stanley says that the CAA should focus on safety regulation, that UK airports should be opened up to more competition, and that the economic regulation of airports should be passed to a new, independent regulator.

 

[gview file="http://www.adamsmith.org/wp-content/uploads/response-to-caa.pdf"]

Patient Centred Medical Regulation

5 per cent of doctors are estimated to be making the wrong decisions - that amounts to 5,000 doctors with 100,000 patients. There is a need for improved regulation of the medical profession with the emphasis centred on the patient. Currently the public is untrusting of the medical profession, This briefing paper sets out guidelines for a new shape to regulation.

 

[gview file="http://www.adamsmith.org/wp-content/uploads/medicalregulation.pdf"]