There is currently a row within the Labour Party in the UK, with the general election approaching, over English health policy. So-called Blairites such as former Health Secretary (1999-2003) Alan Milburn have attacked party policy to make the NHS the 'preferred provider' as opposed to having mandatory tendering of every service, open to private providers both national and international. That is, Milburn and others seem to support the Health and Social Care Act of 2012, following former Conservative Health Secretary (2010-2012) Andrew Lansley's White paper of 2010. It is Labour policy to repeal this.

Milburn warns that 'reform' must not be abandoned. But why should 'reform' be neo-liberal reform? Why should all services be tendered, not least with the advent of the TTIP (Transatlantic Trade and Investment Partnership) between the EU and the USA which might make privatised services irrecoverable to the public sector? The costs of market reform - both non-recurring and recurring - have been huge (see my paper, 'At what cost? paying the price for market reform in the English NHS?' for the CHPI: www.chpi.org.uk; 2014, March). Milburn's own reforms (2001-2) were disastrous in terms of cost and opportunity cost and had to be reversed (2005-6.) 

The academic research which suggested that competition produced better outcomes between 2006 and 2009- even were it not contentious, which it most certainly is - found that that it was INTRA-public sector competition which worked, and that private providers were immaterial in producing better outcomes. So why should the NHS not be the 'preferred provider'? Only if that means that local purchasers are only allowed to use their local NHS providers would that be 'protectionist', if one is assuming market behaviour (itself a self-fulfilling prophecy, often.) But that was never the case between 1948 and 1991, when the 'market' began in the NHS, and would not be the case now.

It seems that the Blairites such as Milburn and Lord Norman Warner are fighting a broader battle for the soul of Labour, as well as carping at their loss of influence.

Ironically, Labour's plans can be legitimately attacked - but from a very different angle. Giving the NHS budget - unified with the local council's social care budget  (which in the UK means non-medical care for patients or clients which is difficult to differentiate from medical care on the 'pathway' of care) - to local councils' Health and Wellbeing Boards would be yet another re-disorganisation, however well-intentioned. Moreover it would deepen the split between purchaser/commissioner and provider, which - despite the orthodoxy of the age - has been an expensive failure. Thirdly, it would unify medical and wider social care in one budget, which might actually harm the effective distinction between the two and diminish the overall pot available - as well as confusing free NHS care with means-tested social care.

So, Alan, pile into Andy if you will - but not on such a stale agenda.

Let me end with a quiz: which is the only political party campaigning to end the Private Finance Initiative in the English NHS?