"The right debate should be about whether the structures in the new NHS have any prospect of achieving those goals more effectively than the central control of the traditional NHS."
DR STEPHEN BLACK, HEALTH MANAGEMENT CONSULTING, PA CONSULTING GROUP
Steve Richards obfuscates the debate on NHS reform by his statement that "this policy marks the end of the NHS" (18 January). He seems to confuse the goals of the NHS with the means of achieving them. The traditional goals of the NHS are the provision of care that provides universal coverage, is free to patients and of consistently high quality. And we should add the practical constraint of being affordable (which in practice means that productivity needs to improve over time). None of these goals is undermined by Cameron's proposed reforms unless there is a secret conspiracy to bring the "evils of US healthcare" to England.
The right debate should be about whether the structures in the new NHS have any prospect of achieving those goals more effectively than the central control of the traditional NHS. And we shouldn't accept the default assumptions of the opponents of reform: central planning has rarely, if ever, achieved consistent high quality, or improvements to productivity, and has frequently failed to provide the equivalent of universality. For example, East Germans didn't have more cars than West Germans, and the cars they had were Trabants not BMWs.
There is plenty of room for a debate about whether GP control of a budget dispensed to providers competing for patients will work. But it isn't the end of the NHS.
Dr Stephen Black, health management expert, PA Consulting
Group, London SW1
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