Britain Plans to Overhaul Health Service

Britain’s Conservative government on Tuesday unveiled the most radical shake-up of the country’s cradle-to-grave National Health Service in its 40-year history.

A 100-page draft law, known as a white paper, was presented to Parliament by Health Secretary Kenneth Clarke. It is aimed at giving greater flexibility to hospitals and doctors and, for patients, a wider choice of treatment and physician.

The proposal is subject to approval by Parliament, where the Conservatives enjoy a comfortable majority.

The opposition Labor Party, which introduced free health care after World War II, accused the government of setting out to wreck the system.

Left-wing health workers’ unions were outraged.

Rodney Bickerstaffe, leader of the biggest health union--the National Union of Public Service Employees--described the proposals as a “cynical charter” to replace the NHS with “a commercial circus.”

“Treatment will be price-tagged, leaving the poor, the chronically sick and the elderly out in the cold. Sick people will be shunted round the country in a scramble for the cheapest care,” Bickerstaffe said.

The plan was seen by some as an attempt to borrow from the American health system, with its emphasis on private care, without increasing spending.

“In other words, excellent care, eventually, for perhaps as much as three-tenths of the population, but deteriorating health care for the remainder,” said Dr. David Owen, a physician who leads the centrist Social Democratic Party.

Government officials said the reforms would streamline the health bureaucracy and give the public a wider choice while denying no one access to free treatment.

It is a “change of pace, rather than a change of direction,” Clarke told Parliament. “The National Health Service is and must remain open to all regardless of income, financed mainly out of general taxation.”

Thatcher Makes Pledge

And in a foreword to the white paper, Prime Minister Margaret Thatcher said: “The National Health Service will continue to be available to all, regardless of income, and to be financed mainly out of general taxation.”

Insisting that patient choice will be extended, she said: “The proposals represent the most far-reaching reform of the National Health Service in its 40-year history.”

Under the plan, the 320 biggest and most sophisticated of the 2,000 state-run hospitals in Britain can become self-governing in 1991, taking fee-paying private patients and billing local authorities for the others.

Breaking another postwar tradition, the self-governing hospitals will charge patients for extras such as choice of meals, private telephones and television.

For the first time, too, private health insurance for the elderly, the biggest burden on the state system, will be tax-deductible.

Other changes planned over three years include fining general practitioners who resort too readily to prescribing medicines.

Family doctors with big practices will get separate state budgets to buy drugs and hospital treatment from private, state or self-governing hospitals for elective surgery. They will be allowed to keep half of any savings on the drugs budget.

Consultants and general practitioners will have their costs independently audited and, like hospitals, will be encouraged to compete for patients.

Labor’s parliamentary spokesman on health, Robin Cook, said the plan was the work “of people who will always put a healthy balance sheet before healthy patients.”

The National Health Service is used by 90% of the population and has a staff of 1 million.

It is funded out of general taxes and a compulsory 10% deduction for health and state pension contributions from each employee’s salary, which employers have to match.