The following contribution to the fierce debate on the reform of NHS England is published in today’s Guardian from WIHSC Visiting Professor, David Hands.
You are right (editorial, 16 March 2011) to suspect that the government’s proposal, in England, to delegate the budget for NHS specialist services to self-interested GPs conceals a ‘darker agenda’. The clear initial steps to wholesale privatisation, destructive competition and fragmentation are graphically illustrated in Professor Kieran Walshe’s study which you published in the same edition.
International evidence unequivocally demonstrates that markets in healthcare distort access, promote inequity, and diminish choice and quality. They encourage unnecessary interventions and consequent damage to patients. Fragmentation increases public expenditure at a faster rate and makes it more difficult to control. These are the reasons why both Scotland and Wales are re-committing themselves to an integrated, co-operative and, therefore, more cost-effective approach to NHS development.
Ian Gilmour, a member of the Thatcher cabinet, subsequently reflected that the introduction of the ‘internal market’ in the NHS in the 1990s was “a triumph of ideology over experience”. Tragically, history is repeating itself but with predictably even more disastrous consequences.
David Hands (Professor)
Visiting Professor in Health Policy and Management
The University of Glamorgan