Cameron: reform means competition

Prime minister David Cameron has underlined his government’s determination to introduce more competition to the health service in a speech on public service reform.

Cameron told the RSA in London that he did not just want his government to “fix” the economy. Instead, he said he wanted the “complete modernisation of our public services” and “to make our schools and hospitals among the best in the world.”

He then went on to underline that his vision for modernisation was “to open [schools and hospitals] up and make them more competitive”, with users making personal choices between competing institutions, backed by public money.

“We are saying to any parent or patient: you can choose where your child gets sent to school or where to get treated and we’ll back that decision with state money,” he said.

Even so, Cameron insisted that his government was not simply pursuing the policies of the right which, he said, had been guilty in the past of ‘focusing too much on markets’ – while the left had ‘focused too much on the state’.

He told his audience that he valued public service and insisted there was a role for the state to: “Ensure clear, basic standards are met, the rights of users are maintained and independent inspection is carried out.”

At the same time, Cameron claimed his government would give more power to public service professionals, letting GPs take over commissioning and some health workers set up social enterprises to deliver health services.

He did not address how any conflicts between GP commissioning decisions and patient choice would be addressed, or whether his government sees inspection or choice as the basic mechanism for ensuring quality.

He did address persistent criticism that the government is moving too fast, saying he wanted to act before “institutional inertia against change” took hold, as it had done during Tony Blair’s New Labour administrations.

He also insisted that reform was needed to drive efficiency and to drive health outcomes up to European standards, now health spending has reached European levels, as Blair promised.

“I know there’s a hunger for this,” he added, citing as evidence the fact that 141 pathfinder consortia are now in place, covering “more than half of England.”