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Wanless thing to worry about

Whoever drafted Gordon Brown&#39s pre-Budget speech decided to present us with a new political mantra – Wanless.

In fact, to much Tory mirth, the Chancellor repeated the word Wanless so often in the section of his speech on future NHS funding that it took on its own chant-like effect.

Maybe that was Brown&#39s int-ention. Repeat the words often enough and everyone will believe them – that there is no alternative to funding the NHS by any other means than general taxation.

This mantra has a somewhat chilling air to it. Was “There is No Alternative” not the equally emphatic mantra of another political figure who had an equally unshakeable belief in her own political “correctness”? Fortunately, for an adult political debate, the dust had barely settled on the Chancellor&#39s words when up popped Mr Derek Wanless – he of the mantra – to sing a slightly different song from that of Mr Brown.

Yes, the “tax-funded system remains the most fair and efficient way of funding the NHS,” sang Mr Wanless. But, and a big but, it was not his job to “bury alternative funding models”.

In fact, the former NatWest man is going to consult the ABI and others about those alternatives. And since the pre-Budget report, the political waters have become even muddier as Tony Blair has stepped into the debate, commissioning former CBI director general Adair Turner to produce yet another report looking at more private and voluntary involvement in the NHS.

The Turner initiative merely reads and sounds like just ano-ther chapter in the Blair/-Brown feud but what are we to make of all this? Just where is the role for private sector funding/provision? And what is the likely policy outcome in the near term?

First, there is no doubt that the NHS remains massively underfunded, if only as measured by the public&#39s desire to see the level, quantity and quality of health care rise year on year. Wanless claims there has been underfunding of around £250m since the early 1970s.

Yet, this is not a new debate. Funding healthcare has been a zero-sum-policy game since the late 1940s as the arguments have festered over ideology and not patients&#39 needs. The last Conservative administration&#39s attempts at injecting private finance – GP fundholders and NHS trusts – went some way to tackle the supply side but failed miserably at tackling the most difficult of all issues – rising demand.

The Labour manifesto in 1997 placed public services at the centre of the agenda but Blair&#39s then mantra of education, education, education focused the first New Labour term on schools. However, the message from the June 2001 poll was to now focus on the crumbling state of the NHS and wider public infrastructure – hence Wanless.

Since 1997, the private sector in healthcare provision has been lobbying hard to gain the public-private partnership deals to operate parts of the NHS – a train set in motion by the previous Conservative administration.

But there have been very little major initiatives around the role for the private sector in future policy development. You can understand this – in an environment where you are in a pitch to gain a PPP deal, you do not want to go around upsetting policymakers, do you? Wanless or Turner, Brown or Blair, the debate on funding is opening up for the first time since the late 1980s.

For the first Blair term, the Government&#39s financial services agenda concentrated much on the pension and savings debate.

The result was stakeholder and Isas and the jury is still out on both. However, arguments around funding healthcare gathered dust. If this is to be the term of delivery, as Blair has characterised it, then innovative health funding must be part of this agenda.

If not, the chronic underfunding will remain for now and future generations. For much of the stakeholder deb-ate, the Government focused attention, quite rightly, on the best and most effective way of delivering the new scheme to the market – the workplace.

Until now, only the Conservatives had thought about health delivery away from existing mechanisms. But the Tories focused on encouraging individuals to make their own provision – all right if you have the ability to do so.

The Labour Party has been, and perhaps still is, after Gordon Brown&#39s interpretation of Wanless, locked in the public good private “bad” argument. The patient, or healthcare “consumer” to use current parlance, remains locked out of any kind of innovative solution.

Stakeholder distribution may provide an even more effective model for healthcare. A possible answer might be Government subsidy to inc-rease provision of private sector health insurance in the workplace might just be the answer. This does not only mean private sector options being promoted more heavily to those already working for private companies or individuals.

What could unlock massive funding potential is opening up private, insurance-based alternatives to public sector workers by means of a Governmentinspired scheme.

Now this, of course, means breaking up loads of interests – unions, doctors – but why not? This is just the kind of radical surgery that the private sector needs to start articulating and soon to No 10, Adair Turner and even Mr Brown himself.

If Wanless did mean public “good” private “bad”, then we should all get ready for higher taxes. Wanless says there is a role for the private sector. If there is, the private providers need to articulate it – and quickly.

Iain Anderson is director and chief corporate counsel at Cicero Consulting


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