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In Defiance of the Evidence: Conservatives Threaten to “Reform” Away England's National Health Service

David Cameron's Conservative-led coalition government is pressing ahead with a highly controversial bill to “reform” the National Health Service (NHS), abolishing existing management structures, opening up provider services to private competition from “any qualified provider,” and establishing a competitive market system in place of planning. The proposals fragment the structures and run counter to the founding principles of the NHS, which in 1948 transcended the limitations of markets, delivering health care on the basis of maximum risk sharing and universal access to services, free at the point of use. Evidence shows markets are a costly and inadequate mechanism to deliver universal and comprehensive health care, and private providers will only bid for services where profits are guaranteed. Opposition to the proposals is strong among health professionals and informed opinion, and the bill has divided the coalition parties—but time is running out for those who reject the bill to mount a sustained and concerted resistance.