Adam Smith Institute

Britain's tax funded health system is no longer the world's envy, but a quaint oddity. It will remain in financial crisis until we bring far more private spending on healthcare. Health costs cannot be met by taxation alone. The institute highlights three areas where funding could be changed. The first is competing funds where 'NHS tax' contributions are paid into a number of 'social insurance funds' of their own choice.The second is charges where there should be co-payments for some minor services, as already happens in europe. The third is cost,taking the responsibility for healthcare funding out of central government and handing it to private or non profit social insurance funds,will increase what we spend on healthcare.

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Professor Alain Enthoven is one of the world's leading health policy analysts. In this paper for ASI, he reflects gloomily on the prospects for real improvements in NHS delivery unless there are more radical reforms than the politicians are contemplating.

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The regulation of clinical practice must focus on the clinical service standards that are delivered to patients, and not on protecting professional self-interest. It must be accepted and trusted as such by the public. We envisage therefore a single regulatory authority that is independent of the healthcare professions. It should be dominated by lay representatives, and perhaps chaired by a lawyer rather than a clinician.

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A critique of what the author calls the 'dangerous delusions of corporate social responsibility and business ethics'. Should we ask more of our business people than that they conduct their affairs as openly and honestly as anyone else?

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The Big Turn Off analyses the attitudes of young people to government, citizenship and community. It shows that only a small proportion of young people share the government view that citizenship means volunteering to do things, challenging the law if they think it wrong, or being active in the community. They have little time for government, be it local, national or European, thinking it largely irrelevant to their lives.

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Simpler Taxes is an indictment of the nation's tax system, which imposes huge costs upon the economy. If taxes were overt, people would realize the huge gap between what they are paying and the services they receive in return. Exploring how globalization and the Internet are making it ever more difficult to levy traditional taxation, Braestrup concludes that governments must, in effect, compete for the loyalty of their citizens with attractive tax regimes. His proposal for Britain is that complex and obscure taxes should be replaced by visible ones which are easy to understand, and whose rates are lower.

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Up to now, access to justice has been the privilege of the wealthy and the minority who are sufficiently poor to qualify for civil legal aid. Most other people had no access to civil justice, a factor which has brought the civil justice system into disrepute. The government is presently undertaking a major and long-overdue reform of the civil legal aid system in accordance with the Access to Justice Act 1999. Reforms enacted on 1 April 2000 abolish legal aid for most civil claims. Instead, it is expected that cases will be funded by the conditional fee system - popularly known as "no win, no fee". In this system the lawyer agrees with his client to charge an additional success fee if the claim is successful, but may charge nothing if the claim fails. It is an example of payment by result. These reforms effectively represent the privatisation of access to justice. The civil courts are increasingly accessible to anyone with a meritorious claim.

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Town traffic causes by far the bulk of the congestion, pollution, accidents, and noise nuisance of driving - all of which cost society seven times what urban motorists pay in taxes. Rural drivers, by contrast, are overcharged three times for their use of the roads. For heavy vehicles in urban areas during peak-hours this discrepancy is even higher, claims the report, which proposes a £15 billion cut in the revenue collected in fuel duty, vehicle taxes and VAT. People driving in towns, however, would pay tolls averaging 5.6p per mile, with charges much higher at peak times and for high-polluting heavy vehicles.

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The Adam Smith institute has told the civil aviation society that Uk airports are over regulated and under-competitive. A report by former airport director David Stanley says that the CAA should focus on safety regulation, that Uk airports should be opened up to more competition, and the economic regulation of airports should be passed to a new, independant regulator. Mr Stanley is an airport Professional who has successfully completed 130 airport commissions in 26 countries over the last 12 years. Full details can be accessed at: www.stanleyassociates.co.uk.

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5 per cent of doctors are estimated to be making the wrong decisions - that amounts to 5,000 doctors with 100,000 patients. There is a need for improved regulation of the medical profession with the emphasis centred on the patient. Currently the public is untrusting of the medical profession, This briefing paper sets out guidelines for a new shape to regulation.

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