The government has published another NHS white paper in which politicians tell the public what sort of health service we must receive. It is time this changed.

After eight years of unprecedented growth in spending, the NHS in England now costs, including charges,£100bn. That is£2,000 per person in the UK. We now spend more on the NHS than on anything else, 50 per cent more than we spend on our biggest item of household expenditure, transport, and double that spent on food and drink.

Our public health expenditure is now comparable with other European countries and yet there has been no commensurate increase in NHS output or improvement in health outcomes. And now some healthcare institutions want more money.

The NHS is the “black hole” of public expenditure, gobbling up money. How long can the current organisation of the NHS continue? The Darzi review will not save the NHS.

At what cost?

The NHS has been managed by setting targets, which have achieved improvements, but often with unpredictable side effects. It is difficult to direct and control such an intricate organisation by central diktat and meet the demands of a modern, complex society and economy. No centralised decision makers can effectively provide a responsive service to meet the health needs of a large heterogeneous population in such a complicated and challenging organisation as the NHS.

The NHS is a politically controlled state monopoly that is inefficient, outdated and unsustainable, a bit like British Telecom in the 1970s. We had no choice, so we had to use it: a poor, limited and expensive service, unable to increase efficiency or respond to customer needs.

If the NHS is to continue to be tax funded, then politicians have to be involved, but their control should be reduced and patients should determine what is provided. Currently, we have no choice but to take the care offered by our local primary care trust.

Injecting competition

If PCTs were allowed to compete for patients and patients could choose the package of care they preferred from the PCT of their choice, then there would be incentives for PCTs to use resources more effectively and provide services more sensitive to the needs of patients. Competition between PCTs to deliver care that is attractive to patients would stimulate innovation and increase effectiveness.

Possible problems, such as cherry picking and cross-organisational services, can be resolved. Politicians would retain only decisions about capitations, regulating PCTs and specifying the minimum audited data set of information they should give patients to help them decide which PCT should be responsible for their care.

At the moment, PCTs’ local accountability is questionable. As the British Medical Association said: “At present, patients and public are seen as noise to be managed.” Giving people the power to choose their PCTs will ensure local accountability.

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