- Associated Press - Monday, January 17, 2011

LONDON (AP) — Prime Minister David Cameron on Monday waded into terrain where past British governments have foundered, promising fundamental changes to the country’s expensive and over-stressed public health care system.

Mr. Cameron said the reforms would cut red tape and improve treatment, but critics claim they will cause chaos and could lead to backdoor privatization of the much-criticized but widely popular National Health Service.

The British leader, whose Conservative Party heads the country’s coalition government, said he would save money and cut red tape by giving control over management to family practitioners rather than bureaucrats, and allow private companies, charities and social enterprises to bid for contracts within the public health service.

Making health care more efficient has proved an elusive goal for successive British governments. The previous Labor administration vowed to reduce waiting times for treatment, and succeeded — but at the cost, say critics, of wasteful bureaucracy.

In a speech outlining the government’s plans to overhaul public services, Mr. Cameron promised to get rid of “topdown, command-and-control bureaucracy and targets.” He said that with an aging population and growing demand for new medical treatments, “pretending that there is some easy option of sticking with the status quo and hoping that a little bit of extra money will smooth over the challenges is a complete fiction.”

The government is due to publish details of its reforms in a Health and Social Care Bill on Wednesday.

Socialized medicine is as much an article of faith in Britain as it is a divisive flash point in the United States.

The health service is Britain’s biggest employer, costs more than 100 billion pounds ($158 billion) a year — and is a political football, reformed and criticized by governments since it was established in 1948.

Despite the constant tinkering, no major political party proposes privatizing the health service, and even free-market politicians like Mr. Cameron go out of their way to praise it.

Mr. Cameron’s Conservative-led coalition government has said health care will be spared the cuts imposed on other departments as part of a 80 billion pound ($128 billion) reduction in public spending through 2015 designed to reduce Britain’s huge budget deficit — and bring the biggest overhaul in decades to public services.

On Monday Mr. Cameron said “a free NHS at the point of use, for everybody” was “part of Britain, part of Britishness.”

He spoke of the care received by his son Ivan, who died in 2009 from cerebral palsy and a rare and severe epileptic condition, and the medical staff who delivered his baby daughter Florence last year.

“All of them have touched my life and my family’s life in an extraordinary way, and I want to do right by them,” he said.

But while some doctors welcome the government’s changes, others claim the scale of the reforms — which will see consortia of doctors take over management from local health care trusts — could cause chaos.

In a letter published Monday in the Times of London newspaper, groups including doctors’ body the British Medical Association, the Royal College of Nursing and trade unions — which together represent many of the more than 1 million NHS employees — warned that the scale and pace of reform made the changes “extremely risky and potentially disastrous.”

The letter said increasing internal competition meant that “with scarce resources there is a serious danger that the focus will be on cost, not quality.”

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