Published: 05/12/2002, Volume112 No. 5834 Page 6 7

The UK will abandon a universally free healthcare system within 10 years, County Durham and Tees Valley strategic health authority chief executive Ken Jarrold has claimed.

Speaking to an audience of health service managers at HSJ's 'Building a Perfect Primary Care Trust' conference, Mr Jarrold said: 'In 10 years, people in this room will be paying for their own healthcare; it will only be free for those who cannot afford to pay.

The NHS will be about commissioning, inspection, monitoring and not necessarily provision.We all need to be preparing for that.'

The former Department of Health human resources director said it was significant that government ministers had begun referring to the NHS as 'an insurance system'. He added: 'The NHS as we know it is over.'

Mr Jarrold was developing the radical theme set by the previous speaker, North Bradford PCT chief executive Dr Ian Rutter.

Dr Rutter argued that current policy was driving the UK towards a system in which the majority of healthcare would not be provided by NHS organisations. Specifically, he said that most PCTs outside deprived inner city areas would quickly relinquish any role as service providers and concentrate wholly on commissioning.

Dr Rutter said healthcare would be increasingly provided by a 'third sector', which would include foundation hospitals as well as the private sector. He said that the three-star acute trusts with which North Bradford worked would 'undoubtedly apply for foundation status' and 'most likely succeed'.

The new commissioning arrangements these changes would create are, he said, 'a huge responsibility and one that few PCTs have woken up to.'

Such was the scale of the challenge facing PCTs that Dr Rutter warned that 'many will fail'. These trusts, he speculated, would be taken over by other PCTs or organisations such as US health group Kaiser Permanente.

Referring to his own PCT's desire to develop diagnostic services, he suggested that successful PCTs would not worry too much about achieving consensus, but instead 'get off the fence' and 'have a go, to see if things worked'.

He was bullish about the performance of his own trust.He predicted it would meet its 2008 waiting-list targets three years early. 'That will mean inpatient waiting lists of three months', he said, 'and I know from past experience that, in effect, because patients want to fit appointments in with their lives, that will mean no waiting at all.'

The conference session addressed by Mr Jarrold and Dr Rutter touched on the relationship between SHAs and PCTs. Dr Rutter said he was 'happy to call [West Yorkshire SHA chief executive] Richard Jeavons my boss'.

Mr Jarrold described a consultation project he had initiated with local care trusts.

He referred approvingly to the response of one PCT 'which said, fifrankly what we want is for you to gradually make yourself redundantfl'.

Mr Jarrold said SHAs - while having an important role now - would become less relevant as the new health system developed. He added he expected them to be eventually replaced with something along the lines of regional health authorities.

lnick. edwards@emap. com