Big bureaucracies are notoriously difficult to reform. They have their own ways of working, and even though these might be 50 years out of date, the time and cost of moving to new ones can be seen as prohibitive by all who work in them. State bureaucracies have it harder than most, because they do not face direct pressure from customers, and do not see their finances ebbing away when they provide a poor service, since most users have no real alternative.
The NHS is the dominant provider of healthcare services, but it is the dominant funder of services too. Nominally, the financing function of the NHS is a national health-insurance system: but it is a highly dysfunctional one.
Note of a workshop in the House of Commons, Monday 10th July 2000
1. 'I see no reason why patients should have to be referred to and from hospital for services which could be provided in their local GP surgery. This is a win-win situation for everyone. GPs are keen to broaden the range of services they can offer, patients want quicker access and less hassle in getting the care they need while hospital clinics and consultants want to reduce waiting times for their specialist services.' (Alan Milburn, 23 June 2000)
What do waiting lists measure?
The newspaper headlines which tell us there are now a million people on NHS waiting lists are rightly shocking. The figure means that one in sixty of us are now waiting for medical treatment. And by no means all of us are even ill. Of those who actually need the NHS to do something for them, it is more like one in six who are condemned to wait.
Could medical savings accounts provide the escape from runaway healthcare costs?
Many countries with private health insurance schemes -- the US, Singapore, even South Africa -- have developed the medical savings account idea as an escape from runaway healthcare costs. The idea is to allow insurance, public or private, to concentrate on providing against the big, unpredictable and costly healthcare needs, but to ensure that everyone has access to savings that can be used to provide for the smaller, routine, more everyday healthcare costs.
Before Britain joins the Euro the five economic tests must be passed. Chancellor Gordon Brown declared in June 2003 that four of the five tests had been failed. He was satisfied that British entry would not damage financial services in Britain, but was not happy about employment or investment. Nor was there sufficient convergence or flexiblity.
Here's an interesting statistic: Our dear government is spending our money at the rate of £9.57 per hour for every working man and woman in Britain*. That's twice the National Minimum Wage. Think of it, a burger-flipper earns £4.50 per hour and Gordon spends a further £9.57. A dear government indeed. But do not despair, the Tories have promised to bring that down to £9.11 per hour by 2006**. Hooray for them.
Reform of the welfare state has been a strong theme in public policy pronouncements over recent years. Much of the pressure for reform has come from a burgeoning social security budget and, partly as a result of measures taken and partly as a result of substantial reductions in unemployment in the later 1990s, expenditure growth has fallen back of late. Underlying pressures for increased spending remain, however, and budgets will likely grow more quickly again when the effects of falling unemployment wear off.
Mid-February 2001, and the Prime Minister proposes that we should start an investment account for every child in Britain. A baby bond' that would be invested and would grow. And perhaps even added to over the years in order to give every Brit a useful cash sum at 18. That could help them fund their higher education, or special health needs, or housing costs, or could be rolled into a pension for their retirement. Great new idea, or what?
The police might think it important to arrest those who use force to defend their property, or to enforce motoring laws such as speed limits, or to offer counselling to crime victims, but these are rated the least important priorities by the general public, according to the Adam Smith Institute's MORI poll, published as The Wrong Package.