This was the question that Canadian ministers’ civil servants had to answer in 1994 rather than the more obvious ‘what can we cut?’
Back then Canada faced a similar public sector debt problem to the UK’s at present. In three years they had eliminated the deficit and two years later repaid a third of their debt.
They told every department of state, including health, to look at every programme and ask whether it served the public interest and whether the state had to provide it and if so at what level, national or local.
Anything that could be transferred to the private or voluntary sectors should be.
In opposition the Conservatives seemed very keen to look at the Canadian model, but in Government their enthusiasm has waned. We are back to preserving spending in whole department, notably health and making cuts in other departments’ spending budgets.
Canada cut 20% from government spending over four years across all departments. In the UK even Health will have to make similar savings, faced with growing demand from an aging (and increasingly obese) population but a capped budget.
If we followed the Canadian example and asked which parts of NHS spending could be transferred to the private for voluntary sector, where would the axe fall? What about NHS dentistry? There may be a case for subsidising treatment for children and those who cannot afford private fees but surely the bulk of NHS dentistry could be transferred to the private sector.