The existing (and unpopular) approach of setting targets for the NHS is to be replaced by a set of rights for patients. There are many reasons for the new proposals to be welcomed. The target system created perverse incentives reminiscent of the old soviet economic system where targets drove aspects of patient care rather than being a measure of them. Patients will have a right to die at home and rights to certain types of treatment within defined periods. Also welcome will be increased roles for clinicians in managing services and managing their own budgets.
However, there are important questions still to be considered in relation to how we as a nation deal with the increased possibilities which new technologies offer us and most importantly how are they paid for. Do we go towards allowing patients to top up their care- as has been done with cancer treatments- with the issues which go with this about a 2 tier approach to health care-OR do we have an honest debate with the public about the need for charges or increased taxation to pay for these innovations. All of the planned improvements in health care delivery will have to paid for in some way and improved access to acute care may be made at the expense of services which are less visible or less popular with voters. This is the real debate which has to take place about the future of the NHS