Talk:Alain Enthoven

The Times (London)

May 7, 2002, Tuesday

Milburn 'takes NHS beyond Thatcherism'

BYLINE: David Charter, Chief Political Correspondent

SECTION: Home news

LENGTH: 510 words

THE Government's new NHS funding system was hailed by the architect of the Conservatives' internal market yesterday as being more Thatcherite than the system it replaced.

Alain Enthoven, author of the booklet that inspired the Tories' NHS shake-up, described the system announced after the Budget by Alan Milburn, the Health Secretary, as a logical extension of the previous one. Professor Enthoven's views will embarrass the Government after its repeated claims to have dismantled the "failed" Tory structure and replaced it with a new method for money to follow the patient.

Under Mr Milburn's plan patients will be able to choose which hospital treats them, whether it is in the public or private sector or even abroad. The money for the operation will go with them, creating a "payment by results" incentive encouraging hospitals to compete on quality.

Professor Enthoven, of Stanford University in California, said that, instead of the "comparatively timid ThatcherEnthoven" model, Mr Milburn was describing "a bold wide-open market". He added: "Whether he means it or not, and whether he can or will deliver it, it is a logical extension of the internal market ideas."

Professor Enthoven's 1985 booklet Reflections on the Management of the NHS inspired the Tories' internal market, which split the purchasers (GPs and health authorities) from the providers (hospital trusts). Although GP fund-holding was scrapped by the Government, Mr Milburn has set up local primary care trusts to hold the purchasing funds for doctors. Last week he gave them complete freedom to buy care from any provider.

Professor Enthoven told The Times: "I find it really rather irksome when I hear the Labour Party saying it abolished the internal market because it did not work, all of which is not true. It was a Thatcherite proposal to create the trust hospitals and the fundholders, which have now become the basis for the primary care trusts. You could say, 'Look, Mr Milburn, what is different?'

"If the Thatcher Government did not go further it was because they were vilified for doing what they did. The attacks were extremely vicious and Labour said they would abolish it, but they have done no such thing. They have built on it."

In 1997 Frank Dobson, Health Secretary at the time, said: "We must undo the damage the market has created. The never-ending paper chase of invoices, the flawed measures of efficiency, which concentrate on numbers of patients being treated rather than their outcome."

A spokesman for Mr Milburn said: "The internal market was all about using competition to somehow drive up standards despite the fact (that) there was no real access to information for patients, no way of inspecting and no national standards, all things we have put into place.

"We are also intolerant of failure and do not want the free hand of the market to determine which hospitals should fail - we will intervene before that. What we are trying to do is to give patients choice in the system in a way that raises productivity."