Correspondence following the post 2 days ago – Is anyone brave enough to sort out the NHS? –
We need an honest debate about new means for paying for the NHS, but few politicians appear to have the courage to advocate revolutionary change
Sir, Your leader’s analysis of the problems facing the NHS is spot-on, and the suggestion that the additional financial resources required should be found outside general taxation is absolutely correct (Mar 14). Insurance-based and co-payment schemes work well in many other countries with superior health outcomes to the UK, and neither amounts to privatisation. Those more able to pay for healthcare simply pay more.
This is an enormous “elephant in the room” in any discussion about the future of the NHS. Let us hope that, although no one is likely to debate it before the election, the next government has the courage and gumption to bring into the open a discussion that everyone knows needs to take place, and which must take place if a national health service is to be preserved.
Professor Roger Jones
Editor, British Journal of General Practice, and emeritus professor of general practice, King’s College London
Sir, Your leader on the financing of the NHS was a courageous statement of the obvious. I have known the NHS from its inception, for 50 years of this period as GP, and it has always been underfunded. Innumerable reorganisations have done no more than scratch the surface of this problem.
The reason, as you imply, is that the NHS has become a national religion, and those who adopt the view that the service is sacrosanct cannot be persuaded. There is abundant evidence that there are better alternatives, and no nation ever has, or ever will, provide everything which modern medicine has to offer, free and at the time, to the entire population. Several other countries have better outcomes for longevity, survival rates for common cancers and numerous other indicators. Their systems often depend on an insurance-based scheme and some payment at the time of attendance for those who can afford it. If such schemes are well devised, they need not involve the withholding of care for the less privileged.
It would take brave politicians to advocate such a revolutionary change — and the prospect of this happening does not seem likely until things inevitably become far worse.
Dr Brian Posner London N3
Added 17th March 2015: Lord Crisp is not in favour of co-payments. He correctly points out that co=payments increase vertical inequity, But this might be a price worth paying if the system works better and is more effective, more economical (cost-effective), dignified and ethical, (encouraging autonomy, discouraging paternalism) and more just and fair for the majority who contribute…. Lord Crisp needs to argue against Roger Jones in a public debate.
Put simply, the NHS will be unsustainable unless we get serious about promoting health and create a lower-cost NHS infrastructure
Sir, Many contributors to the debate on the NHS advocate introducing private insurance and/or co-payments (letters, Mar 16). Research shows that these measures disadvantage poorer people and increase costs overall. Perhaps worse, they throw money at the problem rather than addressing the underlying issues. There is no simple financial solution to what is basically a health problem.
Put simply, the NHS will be unsustainable unless we get serious about promoting health and create a lower-cost NHS infrastructure. Health promotion is not new, but we now have evidence of what works. Yesterday’s Times ran articles about reducing obesity and the savings from early intervention in mental health. Most cases of type 2 diabetes could be avoided. Each case of HIV/Aids has a lifetime cost of £360,000.
The NHS also needs to move from its largely hospital-based infrastructure to provide more care at home, use technology and community assets and train staff in new roles. Unless we do this — and take health promotion seriously — we will end up copying the French, Dutch and Germans with higher cost systems and little if any benefit to patients.
Chief executive of the NHS and permanent secretary, department of health, 2000-06, House of Lords