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Sophisticated discussion?
Return government spending to Victorian times?
Make the UK more like Singapore?
Most people in this country think there is a state run collective Health insurance - its called national insurance. But the arguement was made that a hypothecated health fund wasn't sound public finance as it reduced the flexibility of government to move the money round according to the expediency of the day.
This was a mistake because funding of healthcare ceased to be a political issue. Whatever spending was it was not matched to income.
What is happening now is that the NHS is being asked to cut its spending because government income is reduced not because there isn't a need for healthcare or it isn't a priority for the population. It is said that we cannot keep on spending more on healthcare. Why Not? UK spending is still lower than the EU average(and with a massive backlog) and is almost half that of the US.
This crisis is all of the governments own making. It could have said The country is in a pickle because of the decline of our banks to which state coffers became overly reliant but we are taking measures to get out of trouble. In the meantime spending on the Health service will be protected in real terms and increases allowed for to meet increased demand.
There was already acceptance of the purchaser /provider split; the need for fewer better commissioners; and a tactical use of the private sector to overcome waiting lists ; bottlenecks and those areas the NHS hadn't kept up with the new models of care.
What was the problem they were so desperate to cure?
It's seems that many think that the public /private split in healthcare needs to be shifted more to the private sector. The problem with that is that the best ways to do that: tax incentives and running down the quality of the NHS are poltically unacceptable. Not able to do the direct proxies of handing commissioning to GP's (who are judged to be more sympathetic to the private sector) and hiving off FT's to enable them to make alliances with the private sector out of the public gaze(scrutiny powers over FT's are very limited) have been adopted.
Would it have worked? It might have were it not for the reluctance of many gp's; and the coincidental launch of the £20bn savings programme.
It is Sir David Nicolson who has scuppered the governments plans- no one can disentangle the effects of the Bill and the crisis on the ground as crude cost cutting drives the NHS. Sacking many of the managers that keep the show on the road hasn't helped.
Sophisticated discussion? Return to basics I say.
1.Fewer stronger properly governed PCT's without GP control.
2. A commissioning Board with the power to achieve strategic change installed.
3. More scrutiny and control of FT's but enhanced powers to borrow.
4. Move from light touch regulation to stricter regulation to safeguard quality.
5. Long term funding assurance