Labour haven’t actually had any policies of substance on the NHS for their 12 years. Their slogan, “standards, not structures”, is moronic. Unless you get the structure right, you won’t get standards. But Labour’s approach has been to try to get high standards by magic: “targets”. They simply mandate that hospitals must meet certain targets, and act surprised when this doesn’t work, or when managers find they can meet targets by making things worse for patients (appearing to cut hospital waiting times by leaving people in ambulances, for example).

Labour’s second ploy has been to spend more money – they have more than doubled the NHS annual budget. Has this worked? Yes and no. Some things have improved, but some things have actually gotten worse. Hardly a good return on the money. The fact that other countries can get much better health outcomes for much less money should indicate that we need fundamental change.

How can we make the NHS more efficient, and therefore get better healthcare?

The Conservative education policy is a good place to start. The model is that while the state should pay for the education of those who need it, there’s no good reason the state should run it. Parents should be able to spend their child’s share of the education budget at whatever school they like, and anyone should be able to set up a private school to compete for profit by offering the best service.

There’s no good reason for the government to run hospitals, either. But the education and healthcare are not identical. Diseases must be diagnosed first. And they vary in treatment cost.

Reform of the NHS should be based on the principles of competion. We must bust open the monopoly of government hospitals, and allow better hospitals to compete on quality for the same funds.

The first step must be to allow private hospitals to join the NHS. We must allow anyone to take their treatment cost to a private hospital. If they can find better treatment elsewhere, that’s good. If they can’t, then they simply won’t take up this option. If they want to “top up” their treatment cost, that’s fine. If the private hospital is cheaper, even better. We’ll only get real quality if we have real choice, and real choice will only come when the patients control the funds.

The NHS tariff is a Khrushchevian attempt to solve the economic calculation problem — it bases prices on those in other countries (“When all the world is socialist, Switzerland will have to remain capitalist, so that it can tell us the price of everything.” This is a deeply profound statement). “Personal health accounts” may be a way to solve this, but the problem may not in fact have a solution in a state-funded system.

We must allow anyone to set up a GPs’ practice, and should pay them per patient seen. Introducing a GP’s equivalent of prescription charges would be sensible.

Both these reforms require reform of the planning laws to enable companies to set up new hospitals and surgeries.

The Department of Health could then be abolished.

The next step would be to allow individuals to opt out of the NHS all together, and take their share of the NHS budget to pay for private health insurance.

Insurers could be made by law to provide a minimum standard of care, and it could be made illegal to turn down any customer.

Any other suggestions? Daniel Hannan advocates personal health accounts in “The Plan”. The wonderful Anthony Browne wrote a pamphlet for the Adam Smith Institute suggesting a comprehensive insurance-based reform.