It's not the amount of money you spend, it's the way that you spend it

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its-not-the-amount-of-money-you-spend-its-the-way-that-you-spend-it

I've not normally got a lot of time for Professor Julian Le Grand but this point about NHS reforms leapt out at me:

During the same period that we examined waiting times in England in our study, Scotland and Wales, which both explicitly rejected market-driven reforms, have spent more per patient but have seen much smaller decreases in waiting times.

People like me don't run around screaming that we've got to use market mechanisms because that's what Nanny beat into us nor because we are paid agents for international capital: no, we do so because most of the time (and I certainly am willing to acknowledge that this isn't always true) the use of market mechanisms is more efficient. We get more of whatever it is that we want from the resources available by using markets than through any other method we've yet managed to come up with.

That the English system of more markets reduces waiting times (and also, as the Professor notes, increases equitable access at the same time) produces better results than the not market but more expensive Scots or Welsh systems should come as no surprise to those who remember water privatisation. England got for profit private companies, Wales a not for profit mutual, Scotland a government run company and Northern Ireland direct government supply. In terms of cheapness of supply, higher purity of that supply and lower environmental damage from that supply a decade later the best to worst in order was England, Wales, Scotland, Northern Ireland.

This will of course be the most delicious part of both devolution and of the even more fashionable localism that is being promoted. Precisely because different places will try different structures we'll see which of those structures works best in each and every different field. Forgive me if I crow and point out that yes, even in such basics as water and health care, markets seem to work better than not-markets.