When are we to have a debate?

The various parties try to close down debate by dismissing any who try as two faced (-Mandelson) or peculiar (Cameron) on Hannan. There is passion and ideology here, which makes rational debate difficult.

The NHS has three major problems, true whoever is prime minister:

1) It is a free service financed out of taxation. Being free means that patients will tend to overuse or abuse the service, and financed by taxation means that it will generally be short of finance, since taxes are not popular. This problem will get worse, as the elderly part of our population grows, with all the drugs and equipment they need, and the number of working taxpayers diminishes. There will be fewer and fewer paying for more and more.

2) It is a bureaucratic monopoly of such size that it is difficult to control it from the centre. The vast army of civil servants and administrators must try to interpret the wishes of government, while the government must try to monitor some 1.4 million employees in various locations. Proposals to devolve decisions downwards will result in accusations of postcode lottery, as patient needs mean that the full range of services and facilities must be available in every location. The NHS could become even more producer dominated, rather than patient led.

3) The largest workforce in the UK, and among the largest in the world, have votes and will naturally use their democratic power to preserve their situations and resist change if they lose. We are currently witnessing the strikes in Royal Mail, and there were earlier strikes in transport. To the extent that worker power in nationalised "industries" defeats the government, more costs or burdens will be placed on other sectors which do not carry the same clout.

There may be other problems. Of those I mention, the first is the most serious and probably explains why the many complaints we have heard recently have related to older people.

Ultimately reform of the system must be made, and must answer major questions:
How can the system be made more efficient, saving funds for medicine?
Are there any services which are not strictly medical, for which a charge ought to be made? (This already happens - prescriptions, accommodation, etc.)
Currently the government both finances and supplies the health service. Why need this be the case?
Our national socialised health service is the only one in the world, outside Cuba, and is no longer "the envy of the world" in terms of outcomes. Why have other countries no less humane than us chosen to provide health services in other ways?