26 March 2004
British local government is not powerful enough to underpin a switch to a social insurance scheme for national health care, while Conservative Party plans for 'patient passports' to ease the burden on the NHS would compound service inequalities.
These are the key findings of a series of studies of potential alternatives to the current NHS system, undertaken by the Social Market Foundation and published this week.
Following an in-depth analysis, the think-tank warns against tampering with the current tax-funded NHS regime.
Introducing a European-style social insurance system, for example, would be both costly and would place more responsibility for provision in the hands of insurance firms, employers and local or regional authorities, one report warns.
Labour peer Lord Lipsey, who chairs the SMF's health commission, claims that would present difficulties. 'Firstly, there is the question of feasibility: it is doubtful whether the UK has the appropriate social institutions – for example, powerful forms of local government and tripartite industrial systems – required to underpin social insurance schemes.
'Secondly, it would be imprudent to undertake a costly restructuring of the NHS at a time when it is receiving greatly increased levels of funding and when there is a political will to introduce transparency, responsiveness, choice and contestability.'
Lipsey told Public Finance that question marks remain over the capacity of UK local or regional government to assume responsibility for such a vital system, as is done in Sweden, for example.
'The only apparatus robust enough to do that job well in England would be central government, but unless the other institutions necessary for a social insurance system were in place, there would be very little point in overhauling the current system.'
A second report by the panel, which also includes former King's Fund chair Dame Rabbi Julia Neuberger, dismisses 'patient passports' – which would allow patients to take part of the cost of their NHS treatment to spend in the private sector – as a move that would exacerbate current inequalities.
'The subsidy would be regressive – it would be paid for through taxation, often on poor people, while the beneficiaries would overwhelmingly be the better off,' Lipsey explained.
However, the SMF team does issue a plea to the ideological Left to drop its broader opposition to the use of private health providers, arguing that such treatments can bring significant benefits.