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A clean bill for health

3rd April 2006

March 21 2006 was the 60th anniversary of the postwar Labour government's white paper, the national health service bill. What would a new white paper for the NHS today look like, asks Allyson Pollock?

For 50 years the citizens of the UK enjoyed entitlements to health care as a right, and the NHS has endured despite the last 30 years of continuous sniping and assaults. Since 2000, with the launch of the NHS plan and the "concordat" with the private sector, government legislation has been intent upon tearing down the very structures and mechanisms that protected the NHS from market predators and on opening up clinical services to large for-profit corporations. Across the country, the results are unfolding. Patients are now going without care and suffering on a scale that has not been seen since before the inception and creation of the NHS in 1948.

As in 1946, a new white paper would set out the key principles: service on the basis of need and not ability to pay; close attention to funding and delivery; strong public accountability. Market mechanisms must be abolished. These include purchaser-provider split, payment by results and practice-based commissioning. "If this does not happen, the NHS in England is destined to become no more than a logo attached to a group of corporate chains, while all the old health inequalities and fears return."

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