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Nick Seddon is Deputy Director of the independent think tank Reform.

Tim Montgomerie’s idea that scrapping the enfeebled Health Bill and sacking Andrew Lansley will make the problem go away is simply wrong. The three Cabinet Ministers he cites are equally wrong. Today’s task is to pass the Bill. This will clear the way so that the Government can get on with tomorrow’s job – the pressing task of delivering a lot more for a lot less.

The problems with the NHS were identified by the last Labour government. It burns money like no other public service, has poor levels of productivity, and quality is extremely patchy. Scandal follows scandal – whether it’s elderly care, children’s care, hospital care or home care. According to credit rating agency Standard & Poor’s, at least 20 hospitals are in such a bad way they will need “extraordinary support” (i.e. lots of money) from Government. This sum could balloon into billions (indeed, a £5 billion overspend, according to a former Special Advisor to Tony Blair, Professor Paul Corrigan, in a report for us last year) in coming years. This is both a short term and a long term problem. For the sake of the health of the people – and the Government’s deficit reduction plan – reform of the NHS is necessity, not a choice, Bill or no Bill.

David Cameron has repeatedly declared that he wants the NHS to look much like it is today. Actually, we should want it to look unrecognisably better. This cannot be a branding exercise. Nor is it legislation that counts. It is delivery that matters now. The only hope for any Government is to radically improve the service.


The Health Select Committee has called for “fundamental changes to the way care is delivered”. This is also the view of all leading policy experts, irrespective of political colour. A growing body of international evidence shows that a healthy dose of competition saves lives and money, and the OECD and the IMF have both told the UK that we need more competition to encourage creativity, innovation and excellence. These are the mechanisms employed by most other developed countries, from Australia and Japan to Germany and Spain. Across the globe, pharmaceuticals, medical technology and care services are changing at a bewildering pace. To keep up, to have a service that is truly world class, to allow our patients to benefit from the best ideas and treatments, we need to open up the NHS to choice and competition.

Nobody imagines that the Bill will be a cure for all ills, but terminating it will only make things worse. The really hard truth for the Coalition is that when the Bill is passed, the job will have only just begun.

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