Yesterdays´ local elections in the UK took place in the shadow of not only governmental scandals but the ongoing NHS reforms as well. On of many paths to improvement concerns access to care outside of office hours. This is a typical matter for monopolistic health care systems like in the UK or Sweden, unheard of in continental Europe where family doctors make home calls when you need them.

The shake-up of the out of hours health care system in England is "shambolic" and has led to longer waits and higher costs, a committee of MPs now states, according to BBC Health.

Chairman of the public accounts committee Edward Leigh said: "The new way of providing out-of-hours medical care has so far been a costly mess that has left many sick people waiting too long for help."

The NHS Local Trusts has tried to contract providers to take on out of hour’s tasks. New providers are spending 22% more but are not meeting key targets, the public accounts committee claimed. The outcomes? Fewer than 10% of primary care trusts meet targets on assessing patients within 20 minutes of an urgent call. Not very promising…

Contracting care providers is far from easy. Experience from large scale contracting processes, like in the Greater Stockholm County, reveal that success takes much more fantasy, imagination and consumer-style thinking than public purchasing bodies are able to deliver. It tends to be only too much of copying the last tender offer and established routines. First class providers are seldom rewarded and poor ones can stay in business far too long. So the NHS problems are neither new nor surprising.

Well, so the answer is to get rid of competition and a multitude of providers, returning to the safe, monopolistic tradition? Absolutely not – on the contrary! But what it takes is not public intermediaries “translating” the “needs” of the population but ways to allow consumers to express their demand and make own choices. Here we talk of voucher systems, private insurance or saving account models ensuring the individual purchasing power.

Empowering the consumer is different from empowering public bureaucracy! The tough pill to swallow is that old medicine does not work and only radical steps will ensure real change!

Johan Hjertqvist
President