But even more alarming, hidden away in the voluminous operating framework is a brief clause that appeared without public announcement. It will blow apart the unified NHS as a service and turn it into a purchasing agency. Paragraph 5.43 says: \”One new flexibility being introduced in 2011-12 is the opportunity for providers to offer services to commissioners at less than the published mandatory tariff price where both commissioner and provider agree.\” It adds optimistically: \”Commissioners will want to be sure that there is no detrimental impact on quality, choice or competition as a result of any such agreement.\” This is dynamite. When Cameron confidant Nick Boles MP spoke revealing and unwisely of creative \”chaos\” in public services, this is it. The introduction of unfettered price competition leaves all the NHS open to challenge and undercutting from any private company offering temporary loss-leaders.
This is the point of the whole thing.
The State providing a service is one thing, The State financing a service is another.
As far as health care goes just about everyone else uses the State to finance it, not provide it. For the quite simple reason that sure, there\’s a political desire to make sure that everyone gets access to health care, but just about everyone also knows that competition between different providers is necessary to, in the long run, improve the quality of the care being offered.
So, indeed, have the NHS as the purchasing agency, the financier, not the provider of the care itself.
This isn\’t a flaw in the plans, it\’s not some mistake included through ignorance of the effects: this is the very point of the whole process.