It was written by John Redwood, who had just become an MP, and Oliver Letwin, then merely an acivist but now the Minister of State at the Cabinet Office.
Today we publish the paper for the first time online (a reader got hold of a copy and scanned it) because it offers the deepest insight yet into where health secretary Andrew Lansley wants to take the NHS, and how Conservatives regard this prized British institution.
Indeed, four out of five main recommendations made in the 20-page pamphlet are already being put into place.
Britain’s Biggest Enterprise :
– calls the NHS “a bureaucratic monster that cannot be tamed”.
– says the NHS needs “radical reform” and “revolutionary ideas”.
– claims waiting lists were caused by the “system itself” rather than a lack of funds, and that spending more money would simply increase waiting lists.
It makes these five recommendations:
1) Establishment of the NHS as an independent trust.
This is exactly what Lansley is doing now.
2) Increased use of joint ventures between the NHS and private sector
Again, this is central to Andrew Lansley’s bill
3) Extending the principle of charging
This is also being implemented and pushed forward.
4) A system of ‘health credits’.
Letwin explains these would be issued to a patient who could “spend” it in an NHS hospital or “he could choose instead to go to a private sector hospital”. It is virtually inevitable, as it matches up with Letwin’s choice agenda.
5) A national health insurance scheme.
This is the one that isn’t in Lansley’s bill.
However, Letwin and Redwood do outline several different ways in which such an insurance scheme could work differently, even likening it to Car Insurance at one point. They also say an insurance scheme could benefit the private sector, “To a great degree the divisions between the public and private would fade”.
Andrew Lansley is trying to bring forward a similar system where ‘insurance pools’ (GP consortia) would compete against each other in a similar way.
* * * * * * * *
A revolution then? In fact, Redwood and Letwin acknowledge that “it would be foolhardy” to try and achieve everything in one leap
But need there be just one leap? Might it not, rather, be possible to work slowly from the present system towards a national insurance scheme?
Perhaps Andrew Lansley can answer that.
At least now we have a better idea of what the Tories plan with the NHS and why the right of the Conservative party are cheering them on.
Update: Redwood has now distanced himself from his own writing.