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Choice between state funded but private & state funded and provided surely does what opt outs are meant to achieve - budget follows patients/pupils as people make a choice. Opt out look more like letting people take state cash to pay part of what they are paying already for private education or healthcare.

I'd love not to pay tax on my private healthcare but would prefer that we improved the public services through choice first rather than giving me a cash subsidy.

Just watched PMQs. Think DC got that one in the bag OK. One of the commentaters/emailers said he had fastened TB's feet to the floor. Correct! Education Bill as we wanted it. Nulab cant change it. Now if Greg L-W will just take note. Our leader has both style and substance.

Editor, Not sure I accept your point about opt-outs providing a 'market' incentive to drive up incentives and even if I did the aims and values document is right to set out clearly that our commitment to improving public services for everyone defines our mission. All these 'clever, clever' opt-out schemes and policies are distraction from that central purpose and, as the last election demonstrated, impossible to sell on the doorstep.

Surely the main argument in favour of opt-outs is that they reduce the demand for public services, and so, for example, cut hospital waiting lists. I have no objection to this policy statement but am disappointed that Cameron does not seem to be following it through in practice, having apparently ruled out any consideration of giving schools the right to introduce academic selection if the professionals who run them wish to do so, or of taking the provision of health services (as opposed to their funding) away from government altogehter.

The problem is with the state monopoly, which DC is right to highlight. We have known the problems with monopolies for a long time; even one of Atlee's cabinet condemned them in a paper [forget who now, does anyone know?] but for some reason failed to grasp a state monopoly is even worse.

Opt-outs are impossible to sell, even though they make sense, since they are too open to Labour spin and natural resentment which is all too common. "Subsidising the rich" I hear them squeel. But funding should follow people to individual service providers. I'd rather them all be private but for starters all must be at least independent with performance related pay for managers even if NHS owned. This would prove the system works and enable further development later, a phase two of full open competition. We could call it Democracy in Healthcare, as people democratically select providers by voting with their feet.

"Built to Last" is what I have been waiting for. Far from being the bland 'motherhood and apple pie' document suggested by some, even the shiny new BBC-fied Nick Robinson, this is a radical document that at its heart has this section on public services.

I have today joined the party and gone from supporter to activist and the reason is the party now has a clear statement of values that are not just the current leader's but will be voted on by the party. If that's not an effective riposte to the 'flip flop' argument I don't know what is. I think DC is proving to have more ability than some thought.

He certainly has a better appreciation of the long term nature of the campaign to get back into government than those on this blog who just wish everyone would read the 'Road to Serfdom' and vote accordingly.

"Far from being the bland 'motherhood and apple pie' document suggested by some, even the shiny new BBC-fied Nick Robinson, this is a radical document that at its heart has this section on public services."

Are you not worried that this document could prove to be yet another example of bouncy castle politics, and all the Cameronite jumping up and down with excitement about this superficially attractive initiative could turn out to be based on hot air, which will ultimately be a bit of a let-down?

Guaranteed by the state but not provided by the state is exactely how I would describe my own position so I'm positive.

But public services paid for by the state don't have to be run by the state.

I love this sentence. We have to emphasise this at every point. Imprudence Brown cannot stomach such an idea.

I started nurse training in 1953. We usually had enough of what we needed to do the job, there was always a bed available, The Consultant usually called Father or God behind his back was all prevailing, and the penpushers were called hospital secretaries, and almoners. There was a board - memory a bit vague on this one, but there wasnt many of them, and they were not in your face all the time as they are now. We cleaned for England, didnt do us any harm, we only had penicillin and streptomycin, and the sulphonamides, the surgery wasnt as heroic as it is now, but it worked. The worst thing that has happened to the NHS is the legions of managers, and a lott of them are idiots.I wonder what it would take to prune them.

The legions of managers are mostly idiots as Annabel rightly points out, from my experience ALMOST ALL back room "public servants" are utterly useless, especially hospital managers and social services. The doctors, nurses and teachers are constantly struggling under their bad command. "But public services paid for by the state don't have to be run by the state" is a great line, now time to hammer it home.

This disappointed me greatly: vouchers are clearly a good half-way house between full privatisation and state run monopolies...

In other words: the failed socialist settlement stays. Doesn't matter that the NHS is the joke of the western world, and without doubt, the single worst public health care system of any advanced country. Cameron's Conservatives prefer slogans over uncomfortable truths.

Im very much unhappy at the idea of essentially privatising public services. Im not sure if Parents and users will like it. My views here arent completely formed but I am very reluctant to support this on instinct. In the past I have said I dont support City Academies and I still stand by that.

So basically...more money...blairite factoring to the private sector here and there, no reform.

The single biggest problem in the NHS (and all the public sector) is Unison. We need to kill it, and mandate an open shop. Public sector workers, especially those in the healthcare sector have near universal job security. Union action to advance unfair wage bargains is therefore tantamount to blackmail, and given public thirst for reform, in my opionion undemocratic diversion of public funds.
Fragmenting union presence by bringing in private enterprise on a patchy basis will do little to arrest the overall problem of unionization in the NHS. Personally im not won over by local or part private provision anyway, i fear it might create the same sort of under provision, and budget driven decisions the internal market was associated with. Id much prefer a union free public sector without bits and bobs being privatized - id imagine the 'postcode lottery' would become yet more of a problem.

Maggie reformed unions in the private sector, it is the next conservative governments duty to do the same for the public sector.

Cameron and Osborne might like to grow the public sector at a slower rate than the whole economy, but with union pressure for above growth rate wage bargains, this will become more untenable as time goes on.

"But public services paid for by the state don't have to be run by the state. We will trust professionals and share responsibility - instead of controlling professionals in state monopolies."

Excellent sentiment. Can we therefore expect the introduction of a tax-funded voucher system and the total removal of state interference in education?

"Im very much unhappy at the idea of essentially privatising public services. Im not sure if Parents and users will like it."

I'm not sure if I like having my tax money funding an ineffective public sector just because parents and users want to avoid the responsibilities of a less statist system. It's all very well when somebody else is paying.

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