Not necessarily easy to reform in these conditions

The very ambitious reform of the national health system (NHS) English will it bring down the British Conservative Government, as the famous "poll tax" had brought down Thatcher administration The mere fact that this parallel is entered in the British public debate on the recent presentation by Andrew Lansley, the Minister of health, of this reform on which he worked for many years, is shaking the tories elected. As the trauma of the "poll tax" is still keen on the right, and indeed this reform, the main feature is to transfer responsibility for 80 of the total budget of 110 billion pounds of the NHS in the hands of general practitioners, is bold. Even for a conservative party which feared not to create "a bit of chaos" to reform the country...

The "poll tax" was a one-off measure the consequences easy to read. At the end of the 1980s, Margaret Thatcher's Government attempted to establish a local tax on the number of inhabitants in a dwelling instead sit on the housing itself. Suddenly, a poor family with 3 children in a modest house was to pay five times more than a lord in his vast mansion of the Costwolds. This was considered sufficiently unfair to trigger giant demonstrations, punctuated by violence which led to the resignation of the Lady of iron in November 1990.

The reform of the NHS is more complex for the mortals. And touches more sensitive. Free at the point of entry - it only spends nothing nowhere as patient-, the NHS, born in 1948, is one of the favorite institutions of the British. One of the reasons why David Cameron succeeded to make the tories again eligible think much, is that he promised to exempt the NHS of the budget cuts that affect all other departments and publicly praised it the care his young son, disabled, now deceased.

The interlocking Revolution today may seem difficult to read in France, where doctors and public hospitals are paid care issue by centralized insurance system. By and large, the first branch of the British reform is to place the responsibility for the system in the hands of the 33,000 generalist of the country. As for Andrew Lansley, they are the ones who best know the needs of the population. Specifically, the hierarchy, which, under the tutelage of the Ministry of health decided health expenditures, will be replaced by 2013 by approximately 500 consortia made up of representatives of general practitioners. Thus responsible for purchase of health services and medicines to hospitals or other facilities on behalf of their patients, these consortia should enable the NHS to save 1.9 billion pounds a year in costs of operation from 2015, hopes the Government.

Large part of this reform is to introduce more competition between care providers (hospitals, etc.) and to involve more private, if it can align with the prices of the NHS. In doing so, all public hospitals should be transformed into independent entities by 2014. To monitor this new organization, which, according to the left, is "désétatisée" even if free is not given, will be put in place two regulators, one for competition, the other for the control of quality.

For good measure the risk of skidding of such a reform, it must first keep in mind that the NHS is one of the largest employers in the world and that he had enough of the extensive reorganization from the top. The announced reforms already existed in germ under the leadership of the previous Labour Government. But they have never been tried on such a scale in so little time. It then to represent that, even if the NHS will increase its budget, it will be so little to find 20 billion savings over the next five years. Not necessarily easy to reform in these conditions.

The transfer of powers to associations of physicians also means that tens of thousands of employees of the NHS do not know where they will be in two years, even though it is likely that many find themselves in consortia. "All employees of the structure called to disappear are already seeking employment elsewhere;" "However the transition", says a London surgeon. Finally, many in the medical profession and in the political world have the impression that the shadow of this reform areas remain numerous.

The coalition between the Conservatives and the Liberal - Democrats, the political risk is at least double. First, it may that the reform does not improve the situation, while the rate of satisfaction of the NHS made progress in recent years. Then, if the logic of competition is properly applied, explains James Gubb, a skeptical expert of the think tank Civitas, hospitals must fail. But the subject is politically explosive. Since the introduction of this Act, the defeat in the election of an elected for Labour following the closure of a single emergency late 1990s became one of the favourite topics of conversation of conservative politicians. "In the end, the closure of a hospital decision will be before any political", predicted the London surgeon. But then this is the spirit of reform that would be perverted... According to some press articles, even the close circle of David Cameron would have taken on its head by the magnitude of the reform of its Minister. There is no doubt that the NHS must reform itself for an aging population in a State to the degraded public finances. But it does prevent that Andrew Lansley put a great burden on the shoulders.