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I have no doubt that one of the main reasons I was elected to the House was that I promised to bring my clinical experience to bear on the health debate and to stand up for our NHS. I would therefore like to set aside party politics for a moment and give my personal take on the direction that I hope the proposed reforms will take and where we should go from here.
At the heart of the Bill lie issues of choice, competition and clinical commissioning. My right hon. Friend Mr Dorrell set out clearly the huge funding challenges that face the NHS. We have always had rationing in the NHS, but we are squeamish about discussing it. In an ideal world with unlimited resources, unrestricted choice would of course be a good thing, but it is not deliverable. Because of the limited budget, we need to focus on getting the very best value while openly and honestly involving communities in how we do that fairly. If that happens locally, one person’s local commissioning becomes another person’s postcode lottery.
The central problem with unrestricted choice in the form of the “any willing provider” model is that it forces commissioners to act as bill payers and has the potential to undermine good commissioning. What is the point of commissioners designing high-quality, locally responsive clinical pathways that deliver good value for money for the whole community if patients have a free choice of any willing provider and commissioners have no choice but to write the cheques?