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Letter: The future of the NHS: political consensus and the divisions that remain

Sir: Virginia Bottomley's vision for the future of the NHS is most revealing for what it does not say ("So just where do we go from here?", 19 June). At no point does she refer to the benefits of competition and the market in health care. This is remarkable. For a Health Secretary who has presided over the implementation of market-oriented reforms not to emphasise the importance of competition in the future reveals far more than the priorities she does emphasise.

There is now increasing evidence that a market-based system carries high transaction costs. It is no doubt for this reason that Mrs Bottomley emphasises the need to build on the purchaser/provider arrangement and to develop longer-term contracts. She also, quite rightly, emphasises the need for decision making to be based on evidence and sound research on the effectiveness of medical treatments.

These are not matters of party political dispute. The reality is that there is now a good deal of common ground emerging between the political parties and the areas of difference are increasingly narrow.

What, in practice, has happened is that Mrs Bottomley, as Health Secretary, has moderated the more ambitious aspirations of some of her predecessors and has increasingly argued for the benefits of partnership and co-operation in the health service. This has coincided with a welcome attempt within the Labour Party to modernise its approach to the health services. While differences of emphasis remain, it now appears that there is a great deal of common ground between the two political parties. This is very much to be welcomed, as the last thing the NHS needs is another structural reorganisation.

A period of stability and consolidation would be welcomed by both patients and staff. Change will, of course, continue, but it should be based on a more considered approach to reform that builds on recent developments in the management of health services while tackling outstanding weaknesses. The aim should be to renew the cross-party consensus on health services that was so evident in the decades after the NHS was established. Changes in both Conservative and Labour party thinking makes this a real possibility.

Yours sincerely,


Director, Health Services

Management Centre

School of Public Policy

University of Birmingham


19 June