The Conservative Party has recently announced their plan to introduce health passports.  Will they do the job? 

Iain Duncan-Smith certainly thinks so.  He says: "Our proposals would also mean better healthcare for everyone, with choice driving innovation and excellence and more healthcare as we expand the capacity of the health system in Britain. Our proposals would mean nothing less than a revolution in healthcare."

The key idea is the “Patient’s Passport”.   This is a voucher, which can be used anywhere within the NHS.  In contrast to Labour's policy  which allows patients to choose between a maximum of two hospitals selected by their Primary Care Trust, and this only after they have waited six months, the Passport will be effective from the day of diagnosis, and patients can go to any NHS provider.

The Conservatives want to allow patients to take a proportion of the national tariff for any given treatment in order to obtain that treatment from the private sector. Currently, these patients pay twice for their non-NHS healthcare – once for the NHS in taxation, and then once again for their own private care. The Conservatives are still considering precise level of subsidy they would provide. The Finnish model they have looked at is set at 60 per cent of the tariff, although newspaper reports indicate that the Conservatives could adopt a sliding scale according to different types of treatment. 

The proposals do not indicate any details of this but I would guess that it might work like this.  Patients might be able to take 100 percent for life saving treatment for cancer, but say only 60 percent for a non-urgent hysterectomy for heavy periods.  

It is difficult to fault these ideas.  They put purchasing power in the hands of consumers and force providers to follow customer preferences.   The NHS is restricted to doing what governments do best funding healthcare for all, but getting out of the business that government do badly, providing the healthcare.  

All hospitals whether NHS, private or voluntary get paid on the basis of real activity, what they really do.   This places the focus of healthcare on the consumer.

There are two potential problems.  Firstly if governments pay for everything patients demand, patients may demand useless, wasteful or even harmful treatment.   The passport avoids this by only paying for treatments recommended by the patients General Practitioner or NHS consultant.  

The second problem is that it may lead to the creation of a two-tier health service.  People who can supplement their passport get class A care while those who cannot, or will not, get class B.  

The health service unions, the British Medical Association and the Royal Colleges of Nursing and Midwifery will all doubtless make much of this fear, but their scare mongering is unlikely to worry voters overmuch.  

If hospitals have to compete for patients, the standard of even class B care will rise so far above that of the present NHS that it would be foolish to turn it down.  

Nor does the present NHS provide the same quality of care to all even now.  The middle classes, most of whom have friends or relatives who work in the NHS, are already adept at getting ahead of the queue.  

The fact that the NHS will fund only a proportion of the tariff-price if the Patient’s Passport is taken outside the NHS means that the policy retains an element of social solidarity.   

The Conservatives may be radical in the way they plan to shake up providers, but it looks like they still want to keep the best of the NHS.   Hooray for a sensible step in the right direction.

Jim Thornton 20 June 2003