I’ve just seen the letter from the Prime Minister and Deputy Prime Minister to public sector workers asking for how and where cuts should be made.
Focussing the media vocabulary on cuts is missing a trick.
It sounds as if the interest is solely budget deficit reduction.  But this is not the whole story – the solution should also deliver a good service for the public.

Today’s proposed reform to the NHS is not perfect but is long overdue.

While some things (like getting a consultant’s appointment within a fortnight, or a doctor’s appointment within two days, including after work and at the weekend) have been great, I’m still not clear how some of the targets made any sense.
Anything that resulted in patients being admitted to hospital for a few hours in order to avoid an A&E waiting time target being missed is a nonsense.
After all, if you’ve ever tried to get discharged from hospital (as we did with my baby son), it can take 12 hours and a lot of tears and turn into a Kafkaesque nightmare.
I’ve also never understood the Value for Money argument for the Primamry Care Trusts – as far as I have seen their job is to duplicate letters coming to patients from the GPs surgery and from the local hospital (an extra letter from the PCT each time I got one regarding smear test appointments, for example).

But the Private Sector Lite idea that has been proposed is really not that radical.  Look, if you truly want money to follow patient, it needs to mean a real market in the public healthcare system.
Scary rightwing idea?  Not at all.  The model here is France and Belgium.

In Belgium, an insurance-based system (with a decent fallback for those in need) is run by mutuals.
That means no expolitation by insurance companies trying to screw their own customers and avoid paying out a la USA.
While each mutal has a different “ethos” (I used Mutualite Socialiste the first time I lived there, Partena the second, and my husband Mutualite Chretienne) essentially they all do a similar job and don’t have shareholders getting rish off the good health of the scheme’s participants.

What makes the Beligan system seem so radical if you are a Brit is that any genuinely quality provider can sell services within public healthcare system.
The ground floor of most of the apartment blocks on the big boulevards in Brussels feature a number of brass plaques.
Each building offers one or two GPs, or a gynocolgist, a physiotherapist, a dermatologist, a sports therapist…

Reputation counts – GPs are not in control, offering their patient one or two choices of hospital-based appointments – they provide a referral for a specialist and the patient chooses who they want to see.  The mutual says up front how much of the treatment they will refund depending on how public/ private the specialist is – an appointment at a private hospital will be partially refunded (at say 60%) whereas one at a public hospital might be refunded at 85%.

Oh, and in Brussels, it is possible to self-refer if necessary.
The mutual might not refund the appointment, but the truly free market means that it is possible to find someone to see you if you can’tget a referral but are worried about something.

So ultimately members of the public determine where money goes.
Public health with a bigger role for the patient – now that’s radical…