People in many countries are losing faith in politics as usual. Some are returning to the politics of an earlier age, voting for neo-fascist parties such as Golden Dawn in Greece and Jobbik in Hungary. Elsewhere, those calling for transparency and direct democracy, whereby those elected should represent the people rather than powerful vested interests, are achieving success. The most newsworthy example was in Italy, where a party led by a professional comedian emerged as the largest single party in the 2013 general election although elsewhere, the Pirate Party, which originated in Sweden, is ..read more

Mr Birrell has, correctly, pointed out that I was mistaken in saying that the Public Accounts Committee had condemned the franchising arrangements at Hinchingbrooke Hospital. In fact, the Committee has yet to issue a final report. I should instead have said that members of the Committee had condemned it. I was thinking, in particular, of the closing comments of one of their members in their report of evidence taken: “I have to say, this should never ever happen again, because it is a financial disaster for value for money and for taxpayers. ” I should also have mentioned the report into the f ..read more

Just before Christmas David Cameron’s former speechwriter, Ian Birrell, wrote in praise of private sector involvement in the delivery of healthcare (NHS privatisation fears? Grow up). It is no secret that many members of the current government see the NHS, along with the BBC and the Royal Mail, as ripe for privatisation (or what you and I might describe as untapped opportunities for profiteering by their friends and supporters in large corporations). Yet Birrell’s enthusiasm for privatising the NHS overlooks two fundamental characteristics of private companies. They hate uncertainty (as their ..read more

This blog originally appeared on the LSHTM site Something quite remarkable has happened to me in the past 10 days. Normally I find televised sport barely more exciting than watching paint dry and I share Dr Samuel Johnson’s view that patriotism is the last refuge of a scoundrel. Yet, somehow, I’ve found myself avidly watching sports events that, if I knew they existed (omnium, keirin?) I certainly didn’t understand the rules. Now I’m even beginning to understand what the judges are looking for in gymnastics, beyond not falling off the apparatus. So what has happened? It began even before Dan ..read more

Politicians and media pundits from across the political spectrum have been lining up to compare the Health and Social Care Bill to the Poll Tax. The comparisons are obvious. A seemingly simple idea that was scrambled beyond recognition as it was transposed into legislation, that was hugely unpopular, unworkable in practice, and which ended the career of a member of the cabinet and his prime minister. Yet there is a much more recent analogy, Tony Blair’s decision to invade Iraq. The parallels are striking. Few questioned John Major’s rationale for going to war with Iraq in 1990, given that it ..read more

I'm grateful to Lucy Reynolds for additional analysis of the latest YouGov poll on attitudes to the Health and Social Care Bill. The survey was of 1601 NHS staff and was conducted between 17th and 20th January 2012. If you take out the don't knows, the figures work out like this: Of those who expressed an opinion: 80% expect the new system to be more costly, 89% think it will increase bureaucracy, and 78% think it will be more fragmented. 84% expect quality of care to deteriorate as a result of the passage of the Bill. 91% think the reform will introduce too much competit ..read more

Lucy Reynolds and I offer our views on the provisions for competition in provision in the Health and Social Care Bill “It is not from the benevolence of the butcher, the brewer or the baker that we expect our dinner but their regard to their own self-interest.” Adam Smith, 1776[1] “That any sane nation, having observed that you could provide for the supply of bread by giving bakers a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg is enough to make one despair of political humanity.” George Bernard Shaw 1913[2] EXECUTIVE SU ..read more

Some time ago we wrote a widely cited Lancet paper setting out what we considered a reasonable way forward for public health in England. However, it was clear that the Secretary of State rejected our arguments and he said so, very clearly, in a letter to the Lancet in response to our paper. We then responded to his letter and expected to see both in print very soon. unfortunately he has decided to withdraw his letter, so neither will appear in the pages of the Lancet. Obviously we can't publish his now withdrawn letter, but we thought you might like to read our reply: Dear Editor, We were su ..read more

David Cameron is right. The NHS must change as the population and its health needs change. Yet this is what it has been doing since its inception. Once orthopaedic (literally child straightening) surgeons spent their days treating young people misshapen by polio and spinal tuberculosis. Now they replace the joints of old people disabled by arthritis. Cardiac surgeons once treated hearts damaged by rheumatic fever; now they treat hearts damaged by poor diets and smoking. These and many other health professionals and managers have never had any illusion about the need to change and even, when ca ..read more

25 years ago the Rockefeller Foundation convened a group of scholars to explore the concept they termed Good Health at Low Cost. It was somewhat of a misnomer, as it was less about cheap health care and more about the ability of countries that had limited resources to achieve good health outcomes. The group met at the Rockefeller Centre in Bellagio, Italy, and examined in detail the experience of four jurisdictions, China, Costa Rica, Sri Lanka and the Indian state of Kerala. Cuba would have been included but wasn’t, for political reasons. The project identified several key features of the suc ..read more