The most exciting proposals in this report are for "election of local health boards, the election of PCT
CEOs,..".
Direct elections would enable the National Health Service to find its own direction, avoiding the twin pitfalls of stifling state bureacracy and the unfettered free market.

Since that paper was published by Compass, things have moved on very quickly. Although there are opt-outs in GATS and in EU legislation, the UK is insisting on proceeding with privatisation of the NHS. To that end, all the strategic national and local administrative structures of the NHS have been repopulated with business people, whose remit is to restructure the NHS into packages that can be put out to competitive tender. Private healthcare companies have even acted as consultants for the preparation of these packages. Support KONP (Keep Our NHS Public). I would welcome more frequent Compass updates about the NHS, and much closer day-to-day monitoring.

A useful starting point for the development of a unified voice on the NHS was cast by Alec Nove/Ernest Mandel in 1987 ( NLR 159/161), writing at the same time for the Llodys Bank Review (June 1984) was Rudolph Klien, who modelled the scenario's for a combination of public only/ private only and mixed economies.

The relevance of these discussions today is that they serve to remind us of where the left was at before 1997 and how this thinking behind the thinking is shaping the UK experience today.

As ever the deveil is in the detail of the new emergent issues not captured by this early commentary ie anti-competitive behaviour, corruption and fraud. Incidentally, EU case law at present supports the case for solidarity while the current policy drift is also providing the platform for standardisation and harmonisation.

At present Local Authority Overview and Scrutiny Committees have the powers to ensure full and proper review of all significant changes to health services under s11 of Health and Social Care Act 2001.

How many times this provision has been used is not known. Similary, analysis of current spend between sectors and third party provision is not known, nevertheless, within the last 72 hrs approximately 400 tenders for health and social work services will have been advertised.

Is it anywonder there is confusion and mounting anxiety. This debate is long overdue.