NHS Reform: towards consensus?

This report, which calls for an end to today's centralised health service and the adoption of competing european style social insurance system, has been endorsed by prominent health experts. The main thrust is that the government should neither provide nor finance health, it should merely regulate. Instead hospitals and doctors should be made fully independent of Whitehall, in the form of local trusts. Families would subscribe to one of a number of social insurers, who would then buy services from one of the independent providers. Ex-minister Frank Field says that "if the present government's reforms do not soon show signs of success, a system of competing health suppliers regulated by government and run on insurance lines will begin to be practical politics."

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Getting Back Your Health

People in good health should be able to get part of their taxes back and take the money to a private health insurer or company health plan, according to actuary and City University professor Philip Booth in a new report for ASI. This would give patients better choice, driving down costs and driving up quality as new healthcare providers bid for their custom.

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Unbundling the Welfare State

In this part of 'Unbundling the Welfare State', Professor George Yarrow argues that Alistair Darling must confine the government to the relief of poverty and allow the private sector to take up the task of providing basic pensions an social security benefits. He states that the welfare state has become riddled with complexities, inconsistencies and perverse incentives, and positively discourages low-income families against savings and insuring themselves for future needs. He sees means testing as a tax on personal saving and that the government must focus on improving the market.

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Making Pensions Simpler

Abolition of all benefit and contribution limits, except those on lump sums would produce a massive simplification of the non state pension sector. With little or no scope for abuse, given the recent erosion of pension tax privileges. But real simplification is possible only within the context of broader reforms of anomalies and complexities in the tax system, in how different pension schemes are treated, and in the relationship between pensions and the structure of social benefits.

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The People Economy

First, there was the agricultural economy, then capital became the key productive resource. But the driver of wealth-creation today is the talent and brainpower of individuals: we live in a People economy. And since people are both diverse and mobile, governments and social scientists now need to change the very way they think about job-creation, regional policy, taxation, social solidarity, welfare, and much more.

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The New Shape of Public Services

Public services must be changed, not just funded. This report outlines the new vision for the NHS and state education which would make them more innovative and consumer focussed. The key is to make the public services producers "free–standing, self–owned and independent". They would manage their own budgets and set their own policy and priorities. Parents choosing a school would direct the government funding for their child to the institution they selected. Doctors and patients by choosing a particular hospital for a course of treatment would direct state funds to that institution. State schools, universities and hospitals would be driven by the demands of their customers. The public services would have to improve quality and efficiency.

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The Wrong Package

The latest book in the series from the Adam Smith Institute and MORI looks at the delivery of public services. The findings of the report highlight the differences between the consumer agenda and the producer agenda. The new survey looks at three services: police, schools and local government and the conclusion from all three is that what they deliver is not what the public want. The public want the police to tackle criminal gangs and organized crime, muggings and street crimes, prevent burglary and recover stolen property. A huge majority of people say that teaching the basics - reading, writing & comprehension - should be a top priority. Local government should concentrate on CCTV, keep council estates in good repair and tackle litter, graffiti and dog dirt. The disparity between what is delivered and what is wanted is clear to see.

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A Class Act

While both Labour and Conservative parties talk about the value of parental choice in education, other countries are actively encouraging it. "All state schools could become independent." says the reports author, former Fabian society research chief Stephen Pollard. Examples are given where the public funding private provision model is successfully being used. In America charter schools, which have been set up by local parents receive tax funding, are non selective and are exempt from much of the regulation imposed on state schools. New Zealand has copied the charter school model, replacing the old district bureaucracies with new boards of trustees for each school and has abolished zoning. 82% of New Zealanders now claim to be satisfied with their children's education, and 97% of low income families being satisfied. Equality and educational standards would both rise if the government stopped running schools and paid others to do it instead.

You can read it here.

Paying for Medicines

A new ASI report suggests that Britain should follow Sweden, Norway, Holland and Belgium in asking people to pay the first £60 of their annual prescriptions bills. This would bring an extra £2 billion into the NHS, cut the waste of 'free' medicines that are never taken, and would allow patients to weigh up whether expensive new medicines – unavailable on the NHS today – were really worth paying for. Is £60 too much? It's only a sixth of what the poorest families already spend on booze, betting and baccy, says author Ian Senior.

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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 the politicians are contemplating.

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