It is an axiom, enforced by all the experience of the ages, that they who rule industrially will rule politically.

Aneurin Bevan, ladies and gentlemen. Welshman, politician (secretary of state), author, and architect of the National Health Service. It is he, to my mind, that we have to thank for Social Welfarism all over (and, in particular, Australia).

The changes face(s) of which – the NHS – becomes the subject herein.

Number 1: the British United Provident Association has decided to split its health division from its insurance division. The Health division consists of some 25 provider sites, worth GBP1.44bn to a concern called Cinven (who comes up with these?). BUPA sites provide non-emergency care, and do so at a time when the NHS is sending ever more patients out of the NHS for treatment.

So BUPA sees more private care of NHS patients, and wants out. Cinven see a bigger buy-in:

Cinven, which like BUPA is based in London, two years ago paid £552 million for Partnerships in Care, which provided services to patients with mental health illnesses. Cinven has also owned General Healthcare, which it developed into the biggest private hospital provider in Britain, according to the statement, and a stake in Générale de Santé of France, now the largest private clinic operator in Europe.

This is becoming not unlike Australia’s Medicare: our universal health insurance is just that – a finance mechanism, not a provision mechanism. Australia actually has quite a robust private hospital sector. This is a reason why the likes of waiting times don’t matter so much there. Medicare makes very well-managed use of the ’safety-valve’ of private treatment, just as the NHS, which is actually a universal provider, not payer, is now seeking to do. All of which is going to make the UK’s system rather murky indeed.

I wonder how Blair’s investments in the NHS will come be judged, if this trend continues.

Number 2: Related to the NHS, and how it functions (or disfunctions, pending the disposition of one’s interlocuter). David Cameron’s long-awaited blueprint for NHS reform will be set out tomorrow in a Tory white paper that seeks to abolish government targets for reducing waiting times, the Guardian can reveal.

I will never ever become tired of British media’s knack for reporting tomorrow’s news today, literally. I love it. The Tories plan involves:

• GPs’ salaries to be linked to the success of the treatment they deliver and the extent to which patients are satisfied with the experience
• abolition of all central targets, including the government’s current commitment to reduce waiting times to 18 weeks by the end of next year
• control of the vast majority of NHS budget to be passed to GPs, who would use the money to commission services for their patients
• patients with long-term conditions to get “individual budgets” to buy services such as therapy and home visits
• NHS and private hospitals to be allowed to compete on price, offering discounts to encourage GP commissioners to send more patients
• all hospitals and community services to be encouraged to become self-governing foundation trusts, with freedom to borrow for investment on the open capital markets

That one about GP funding ought to go down well. Roy Carr-Hill may appreciate being let off for a while, at least (not true. Knowing Roy, he probably had been rather enjoying it). Mind you, that move of budgeting discretion from Trusts to GPs will be popular. The idea that outcomes will determing GP payments, where outcomes at least in some part come from patient-driven feedback mechanisms, will be a worry. Individuals can’t be relied upon for information about their own health, so why we should trust them to judge their care to such an extent is worth questioning.

The other noteworthy element is the introduction of price-competition, for both Trust and private hospitals, and the abolition of central targets (see the previous about waiting times). This might at least take some time and energy away from meeting numbers requirements – whether it goes into better health outcomes will (hypothetically – Cameron still has to win the election) remain to be seen.

Brown’s own ‘people’ had mooted the idea of NHS independence (managed by an independent board) – much like independence of the Treasury. There’s something very appealing in that idea, as though health outcomes can exist independently of parliamentary policy, like inflation and interest rates. I don’t know how feasible that is, but it is such a nice idea. There’s a cleanliness about it (which I clearly can’t describe at all well).

Nothing, at least yet, on what the Tories would actually spend on the NHS, which is a gap that they will need to fill (Americans, the Brits have content-driven, and policy-driven, elections like you wouldn’t believe. You have no idea how robbed your democracy is by your own Fourth Estate).