For the most part, radical reform of government services cannot occur. Large organisations are inflexible and, in the face of changing circumstances, those that can no longer well function die, and are replaced by the growth of new organisations or existing small organisations into large organisations which, although equally inflexible, are suited to the current environment. As such, reform of the NHS is impossible. The NHS cannot be fixed.
I think it is in fact not merely a matter of reform being impossible. It is also, I suspect, a matter of the British public paying very large amounts of tax and seeing, on the whole, very little for it. The NHS is a very visible service where those who pay feel they are in fact receiving something for all that they pay, and so there is massive resistance to anything which would on the face of it reduce the service provided. The NHS's visibility makes it seem like better value for money than it really is.
I propose, then, a mechanism for making the NHS irrelevant, an approach which requires no reform of the NHS proper and which will not fail in the face of the public's desire to see something for its tax money.
There are now those who pay twice for health care: those who contract to private health care providers, but still are forced to pay for the NHS through their taxes. Clearly, these individuals have removed the burden and costs of their health care from the NHS. Why, then, is it that some individuals pay twice, while others (users of the NHS) only "pay" once? This is clearly unfair, and should be resolved.
I propose a simple reform that leaves the NHS untouched: people who contract to a private health care provider should receive a full tax rebate of the money taken from them for their public health care provision.
As individuals depart from the NHS, the part of tax which which forms healthcare will decline. Accordingly, the rebate will decline. Eventually, with a competitive market of health care providers where the NHS is but a player, the anomaly of its funding being intermediated by the state could be removed and those contracted to the NHS could then, as they would with other providers, simply pay directly.
For this to work, no reform of the NHS is required. The NHS simply becomes a player in the private health market, subject to success or failure by its own merits. Individuals may chose to use the NHS, should they wish; equally, they may wish to use another health provider. Contracts are no longer being imposed by the state. Freedom would be introduced to the healthcare market.