Liberating the NHS: source and destination of the Lansley reform

INTRO (the entire body of this document has been placed HERE)


This important document was written by
Dr Lucy Reynolds (a), Dr John Lister (b), Dr Alex Scott-Samuel (c) & Professor Martin
McKee (a)

a London School of Hygiene and Tropical Medicine
b Coventry University
c University of Liverpool


A narrative for this reform, far more transparent than the double-speak of the White Paper, can indeed be located. It is described in the following pages. It maps a move away from the tax-funded NHS based on the principles of contribution according to ability to pay, and use according to medical need. It takes the NHS towards a US style arrangement of individual health insurance with access to care based on payment of health insurers at a level based on the insuree’s state of health. In other words it removes the pooling of risk which underlies the post-war social solidarity compact, involving subsidy of health care for poorer and less healthy citizens by richer and healthier compatriots. A plan for the end-state system to be jointly funded by the state and the individual solves the perplexing riddle of how the new systemcould generate £20 billion of savings, given that it involves more providers, fragmented procurement, more complex administration, the marketing costs involved in market competition, and multiple layers of profit extraction from the NHS budget,. Cost reductions will be achieved through de-skilling and poorer employment terms for medical professionals as the NHS hospitals which employ them are shifted into the private sector.