The current government has actually saved the NHS. Re the use of private sector - this was often contracts with South African and American firms to do specific things eg cataract operations, and the terms of the deal was that they were to supply their own doctors and their own facilities (usually a sterile unit outside the hospital) - i.e. it was done to work around the BMA, who still give us gyp.

If the govt had relied on the existing in-house system with BMA doctors, nothing would have been achieved as BMA doctors have a vested interest in ensuring that waiting lists for things like cataracts and varicose veins stayed as long as your arm - because these operations are big money for private hospitals in the UK as they are medically easy to do and have big profit margins, but of course people only go private if they can't get it on the NHS. Bringing in the outside suppliers with their own doctors solved that, as the outsiders had no conflict of interest, but wanted to fulfil the terms of their contract, which was to do as many operations as possible to get the waiting list down, and they often delivered at a lower cost than the BMA doctors. Therefore the contracts not only delivered customer care, we saved money by hiring these contractors to do NHS work.

The big flaw in Bevan's system was that he did allow a conflict of interest to build up due to allowing consultants to have both an NHS and private practice. If you are a consultant and private practice is more lucrative than the NHS, you are incentivised to ensure that the NHS has long waiting lists so as to be able to say to your patient, I can get this done for you if you go private, and hey presto, give you a steady stream of private work. 

The current govt tried to solve this in 2003, to end the practice of the consultant being on the NHS payroll but never in the NHS hospital. Under the new deal, consultants were supposed to have tighter contracts laying down exactly how many hours they were expected to do, and they got increased pay as part of the deal. Unfortunately, we overpaid, and trusts have been a bit slack about issuing tight contracts (perhaps because of traditional fear of consultants) - many trusts simply listed what the consultant already did in the contract, instead of specifying additional hours, and were too vague. So the BMA stitched us up again.  BUT, the growth in the amount of private work undertaken by consultants had been halted, and patients were now more likely to be seen by a consultant on the NHS than they were a decade ago.

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What sort of choice leads to hospitals closing and patients having to travel further?

(I see polyclinics as an encouraging form of co-operatives).

I admire the optimism but you're way out of step with pretty much everyone who works in the sector then.

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No, the 'market reforms' are wrong too.  That's why, when Labour came to power in 1997, we got rid of the internal markets put in by the Tories.  I have yet to have anybody adequately explain to me why we have spent so much time since then bringing them back again (the only explanation I can think of was that Frank Dobson was replaced by the likes of Alan Milburn).

The documentary on Bevan contrasted so greatly with the documentary about the new 'reforms' last night, which showed the terrible waste of shoving that well-won extra funding into the back pockets of share-holders, not to mention the way Ben Bradshaw washed his hands of any government responsibility for the sorts of companies local PCTs dealt with.

I don't disagree that it might be possible to have some forms of local co-operatives within the NHS, but let's not pretend that the reforms of recent years have been anything to do with that.

Unfortunately too many decision-makers are bound to a bizarre dogmatic reification of private finance and markets, beyond reason.

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