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Published: 17/11/2005 Volume 115 No. 5982 Page 22

Steve Webb MP; Liberal Democrat health spokesman

To follow the current debate about the NHS would be to conclude that there are only two possible positions.

The first is that an inefficient NHS needs shaking up by the rigours of competition. The second is that there is nothing much wrong that can't be solved by money. Neither position stands up to scrutiny.

The government seems oblivious to the limitations of its marketdriven approach. Markets reinforce existing inequalities. The articulate and mobile will dominate the best healthcare provision. The vulnerable will get a raw deal.

Markets depend on the creation of winners and losers, and the losers are being told that no-one is going to bale them out. The NHS needs keyhole surgery, but it is getting amputation with a rusty hacksaw.

If existing mechanisms for ensuring delivery of efficient healthcare are inadequate, what else can be done if we reject the marketled route to driving up standards?

The key to reinventing the NHS lies in a rediscovery of the notion of accountability. What if accountability and activity in the NHS were to be radically decentralised so local people actually knew what was going on in their local NHS and could help to shape its strategic direction?

The precedent for this model already exists in Denmark. The result is efficient healthcare, with a public service ethos, accountable to local people.

The choice must not be between market mania or a yearning for a mythical golden era. It is time to reinvent the NHS so it delivers top-quality care in an efficient and accountable way. To do anything less would be a betrayal.

Steve Webb last week gave the second in a series of three NHS Confederation lectures, where key players from the main political parties set out their case for the future of health and public services. The third and final lecture is scheduled for the new year.

-www. nhsconfed. org