By Norman Blackwell and Daniel KrugerThree star hospitals can now apply to become free of NHS controls, but the authors argue that this does not go far enough. While the Government retains its monopoly of both funding and purchasing, these nominally independent hospitals will still only have one customer: the state. All the money in the system will still flow downwards, and all accountability will still flow upwards: to Whitehall. The authors argue that only by giving control of spending to patients, and control of delivery to professionals will we have the level of healthcare which we all want. And their proposals are designed to address an inherent failing of the NHS: that it is the poor and marginalised who receive the worst treatment, while the better-off manipulate the system to their advantage or, if they are lucky, opt out of it altogether. Hitherto the debate on NHS reform has been polarised between two extremes: the retention of the state monopoly of funding, and the introduction of private finance through charging, employment-based social insurance and/or private insurance. This proposal offers a third option: to leave British healthcare overwhelmingly financed through general taxation but to give patients and professionals the responsibility for spending that money.
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