I can agree in part with a lot of what you are saying MGspannerman but "If you smoke and drink to excess then its the NHS's problem and not yours." could be extended to anyone who participates in a risky sport or pastime, drives or rides recklessly, eat an unhealthy diet or even get pregnant. The NHS picks up the pieces and aren't we lucky it does.

The NHS is not the hospitals, doctors, nurses, managers etc. It is a commitment by the state to provide healthcare to all free at the point of use. The hospitals etc are merely the means by which the NHS is delivered.

We generally accept that large parts of healthcare delivery are through the private sector - eg: construction, manufacture of drugs and medical equipment, catering, cleaning etc. Dental, opticians, elderly care is already substantially provided.

So I see no reason why healthcare cannot be delivered by the private sector so long as it is very clear the "buck stops" with the government.

There are clear examples of failure in the public health service arising from a lack of proper governance, resistance to change and arrogant assumption they know best. To balance - they also have world leading top class capabilities.

A positive policy of transitioning (say) 15-30% of healthcare to the private sector would be healthy. They may then both learn from each other to implement best practice.

The problem with transferring part of any service to the private sector is that they cherry-pick the profitable parts and don't get involved in costlier aspects - the Royal Mail is a prime example, forced to continue with the universal franchise at standard price while private alternatives can charge extra for longer distance or not accept them at all.

Private healthcare providers aren't queuing up to treat long-term chronic illness patients.

"""A positive policy of transitioning (say) 15-30% of healthcare to the private sector would be healthy. They may then both learn from each other to implement best practice.

The problem with this at the moment is that not that many consultants and GPs work solely in the private sector but feed of it by being in both camps and if things go wrong patients often end up back in the NHS. Private health care also relies a lot on agency staff which again work in both camps, Very often NHS patients go through all the diagnostics such as scans MRIs etc get the diagnosis, and are given the waiting list. They then elect for private treatment and all the scans etc are then available to the same consultants. One could argue than the NHS saves money by not performing the last stage but has incurred costs. I have nothing against this but the same consultants doctors could be performing this on the NHS and the more they devote to private clinics the more the NHS suffers a loss of staff. The way things are heading if private healthcare should expand than there would be far fewer medical staff for people who could not afford the private clinics. Have you tried getting an NHS dentist, they have nearly all gone private.

Have you tried getting an NHS dentist, they have nearly all gone private.

They get paid more privately and get to pick and choose better patients - would you not do that if you were a dentist?

We use a non-NHS dentist who charges NHS rates - some of the private dentist charge rates are obscene.

A positive policy of transitioning (say) 15-30% of healthcare to the private sector would be healthy. They may then both learn from each other to implement best practice.

That's an attractive idea, and is happening by accident or design. But I doubt if the learning actually happens - one group is trying to work within budgetary constraints, the other is looking to increase its turnover.

But I'm wary of privatising provision even when the government is paying. Especially the kind of government we have at the moment. It's pretty obvious that what they are for is finding "investment" opportunities for their clients, the owners of capital. And the private sector runs rings around government as evidenced by PPI, an invention of the Conservatives not withstanding it was raised to an art form by Labour, consequent on them hamstringing themselves by pledging to reduce waiting times while remaining within Conservative spending limits.

Running the NHS efficiently is an elusive ideal. Targets directed at governing the internal market have in many cases been counterproductive. A number of trusts employed costly 'consultants' to recode patients, especially dead ones, so they hit their measures - difficult cases were retrospectively shifted into 'palliative care' among other fiddles. GPs hit their appointment lead times by simply refusing to book anything more than 48 hours in advance, obliging patients to join a phone queue daily until they got one - within the target window. I remember Blair professing shock at this this when somebody told him live on TV, our practice had been doing it for a couple of years by then.

Private providers have the profit objective to motivate them to find efficiencies. But of course the aim of doing the best for patients at the same time creates a conflict, so you have regulation, which is always gamed as it is by the successors to nationally owned utilities for example.

Thatcher's determination to make healthcare operate like business was at odds with how it had developed as the NHS. Hospitals had in effect been run by senior medical staff, supported of course by clerical and menial oompa loompas. Professional managers were nowhere in sight. There was rationing of course which was manifest in the waiting timse for elective procedures. Decisions as to who was treated and when were made on the basis of a set of largely unwritten shared values and ethics, rather than being based on cost benefit ratios with the benefits measured in theoretical QALY's (quality adjusted life years).

The NHS is not safe in the government's hands. There is plenty of evidence that privatisation by stealth is on the agenda even if a privately operated NHS has to remain largely state funded for another decade or two..

We must remember nothing is unthinkable when there's money to be made. Thatcher's 1982 plan to introduce an insurance-funded system only foundered because of untimely leaks. Even a Labour government might not be able to stave this off without appearing to be spendthrift. Getting the electorate fixated on the idea that tax is bad plays right into creating those profit opportunities, just cut the taxes and let people choose the level of insurance they want to pay for...