Whatever you made of the Chancellor’s various sleights of hand on Tuesday,
lurking beneath his Budget plans was one inescapable fact. The hungry maw of
the NHS is swallowing more and more resources, at the expense of virtually
everything else. The defence budget is at its lowest since 1930, despite our
dwindling troops being dotted across three continents. Prison overcrowding
is at such record levels that Jack Straw will have to release even more
inmates early in a few weeks’ time. But the health service marches
relentlessly on, having hoovered up two thirds of the increase in public
spending in the past five years.
Even “enterprise” – once one of Mr Brown’s favourite words – has been tapped.
This week’s new taxes on small business seemed unwise, given the fragility
of the economy. They were also wholly avoidable, had the NHS been awarded
the 3 to 3.5 per cent spending settlement that was expected. But a 4 per
cent annual rise for the NHS, raising its budget from £90 billion to almost
£110 billion by 2010, seemed to have become a political imperative.
Why? Well, 4 per cent is a nice round number. It is also more than half the 7
per cent annual increases that the service has got used to. But it is also
simply very hard to row back once you’ve built an expanded State. This
applies to all public services – which is why I wonder whether Messrs
Darling and Brown will actually meet their lower spending targets – but it
is particularly acute in health.
The NHS is Britain’s last big state monopoly. It is the largest employer in
the developed world. Its 1.4 million staff outnumber the private and public
healthcare workforce of Germany, a country with 25 per cent more people and
better health outcomes. Its powerful unions view any slowdown in spending
growth as a “cut”. And cut is a deadly word in political terms. The
Government had its chance, when it was flush with cash, to demand reform as
a quid pro quo for more money. But it did not go far enough.
In the 1990s it was possible to argue that the NHS was starved of cash. But
not any more. Britain is now spending at about the European average, but
lags behind too many other European countries in terms of results. Far too
many cancer patients, babies and stroke victims are still dying needlessly.
Far too many patients, particularly the elderly, are treated with a
callousness bordering on brutality. Almost everyone I know who has had a
baby recently has been told by the nurses to bring their own Jif, and not to
set foot in an NHS shower without scrubbing it. World-class that isn’t.
Sir Derek Wanless, Gordon Brown’s former health guru, reported last month that
almost half of the extra £45 billion that has been spent in the past five
years has gone on pay and price inflation. The NHS generates its own
inflation as though it were a country in its own right. But the slowdown in
government spending is not, sadly, due to a realisation that there are
diminishing returns to spending in a monolithic health service. It is merely
the Government running low on cash.
The real issues are repeatedly obscured by homilies about the NHS being the
envy of the world. The latest to fall into this trap is Lord Darzi of
Denham, the eminent surgeon who is supposed to be reviewing the structure of
the NHS. Thank heavens he is still practising on Thursdays and Fridays. For
his interim report last week was little more than an advert for the
Government’s two populist priorities: extending GP opening hours and
tackling MRSA. Until then, the greatest worry about the Darzi review had
been that it might delay progress towards much needed reforms. No one had
dreamt that he would be coopted into a propaganda exercise. We do not need a
top surgeon to tell us to wash our hands. Nor to invent another centralised
“Innovation Council” to champion change, a snip at £100 million. The NHS
badly needs more innovation. But you cannot impose it. You can only nurture
it, by liberating doctors and by introducing competition.
If this simple fact is not obvious to ministers by now, then all is lost. For
the limited moves that the last Blair administration made to introduce
competition have paid off handsomely. Letting independent providers carry
out some procedures has slashed waiting lists for hip replacements,
cataracts and heart operations, and has raised the standard for what can be
achieved. Payment by results and the NHS tariff have helped to make costs
more transparent and to give a wake-up call to poor performers. Giving the
best hospitals more freedom as foundation trusts, under a savvy regulator,
has injected a new sense of financial rigour.
Yet ministers have always been embarrassed to claim credit for these
achievements, which are loathed by the unions. They are in the strange
position of presiding over some brave reforms while having to bloviate about
minor issues: free health checks (didn’t we used to get those at the
doctor?) and expanded GP opening hours (which was the norm, until ministers
decided to pay them more to do less).
Ministers are too easily persuaded that the battle is between public and
private provision. They are ashamed to endorse the private. But the real
battle is between those who want to protect their monopolies – including
many private hospitals – and those who want competition. Many NHS insiders
who believe most fervently in the service are those who are fighting for
competition. But they are still an endangered species. It is of no help to
them when ministers send ambivalent signals.
No one is quite sure yet how committed the new Prime Minister is to
market-based reforms. The opposition parties will not ask him. Labour’s
largesse has boxed them into a corner. Neither Conservatives nor Liberals
dare to make the case for proper reform.
That is the real price of having built a bloated State. No one dares speak the
truth, because there are so many vested interests to offend. But the writing
is on the wall: a tax-funded free healthcare system is looking ever less
sustainable. Politicians always fear the “popularity” of our health service.
But that popularity will wane if the NHS comes to be seen as the enemy of
every other public service.
— Camilla Cavendish will be speaking on child protection at the
Battle of Ideas on Saturday, October 27. More details at www.battleofideas.org.uk
i now live in a country where you have to pay insurance for your healthcare, but the service you get compared to the NHS is breathtaking. All my relatives are shipping here to pay but get proper service.The NHS is a dinosaur that is flabby and eating up the country.We need to privatise. And as for free healthcare, those on the brunt end of economic situations should be issued with healthcare insurance vouchers.There needs to be competition.That will end the dangerous incompetence.
karan, dubai, uae
Camilla, say what you're actually thinking, please.. What you mean by 'reform' is privatisation, and I don't know why you would support that, given the complete ballsup that NHS PFI schemes have been?
Owen, London, UK
Is the cleaning of our hospitals contracted out and if so what is the company called or is it done on a local level or do hospital staff carry out the task in hand, who is in charge to oversee that the job is done to a good standard, please help me with this as i have had enough of images of our once world class hospitals infecting patiants at an alarming rate, this needs to be taken in hand now, public tax funds the NHS and the public have a right to clean wards now not later.
if you have elderly relatives awaiting treatment at one of the countrys hospitals are you not worried that they have a very high chance of contracting something life threating whilst our superb doctors and nurses battle on with this stigma, as an MD of a local business i feel the need to take on who is responsible for this total breakdown in hygiene someone is being paid to oversee this task and that person or company have a serious contract to maintain, clearly there is a problem, can i help, IF I CAN I WILL.
Andrew Timothy Norman, Cheshire., England.
The NHS should be relabelled UFHS: universal free health service (to the whole world) !!!!
David Barnett, Liverpool, UK
Have any of you actually been in a hospital recently? I've been training as a doctor for 4 and a half years now, and I passionately believe in the ethos of a system that gives equal healthcare to everyone, free at the point of delivery. This criticism about all the money being wasted on pay - I can promise you that the starting wages for junior doctors has dropped through the floor in the last 5 years - literally halved, because we now have a third less hours. So your junior doctors are now nowhere near as knackered, and cost less to the government then they used to. Nurses wages have gone up - but they do an amazing job - do you really begrudge them that? New hospitals are being built, waiting lists are down, positive cancer outcomes are going through the roof. And you all want to dismantle the NHS? It's the most amazing organisation in the world - try injecting a need for profit into the system and then watch quality drop and costs rise! Some of these views are so shortsighted.
Ian Bullock, Nottingham, Nottinghamshire
Let me guess, Camilla doesn't come from an impoverished council estate or a mining community. The privileged can always use their wealth to buy themselves education, or health services. But most of us are denied this luxury. We rely on state provided services. Private provision (like in the US) means many people are denied acccess to health care. Private provision means profits being taken out of health services in the form of dividends. Private provision is responsible for dirty NHS wards. Private provision cherry picks the easy procedures and leaves the NHS to carry the burden. Let's hear it for the NHS - it isn't perfect but the last thing it needs is more private provsion.
Richard, Matlock, UK
The problem with any arrangement offering benefit free of cost to the user, is that eventually demand is likely to exceed resources planned to fund it.
This can be seen on the micro level when a group meets for a regular meal at a restaurant which is paid for by combining individual bills, with each paying a proportionate share of the total. Over time, individual menu choices will tend to become more expensive, (perhaps encouraged by the establishment) as a me-too sentiment prompts copying greed of others, and the total cost will rise.
If the payment basis is changed to actual individual cost, choices in many cases will become more frugal.
The challenge for both health and welfare cash benefit systems to be viable and sustainable , is to devise systems affordable by and for all which discourage, limit, or prevent claims beyond need
dr venables preller, Warminster, UK
The countries with the best health services are not run by the state, They are run by medics and the state pays insurance for everyone.
Here the state runs the service and it is poor and dirty and dangerous.
Lets the doctos provide the service and let the patients pay the doctors. And let the state provide insurance . That works.
Merlin, Northampton, UK
Just avoid the US model where "the medical" is like another mortgage (for those who can afford it). And the administrative cost of insurance companies fighting not to pay claims is huge.
Peter , Wakefield, UK
The key point is not whether the NHS is tax funded or privately funded through insurance but that everybody has equal access to it at a price they can afford, irrestective if that price is paid by insurance premiums or taxes. Whatever the route taken by the Government it must never emulate the USA system, which is market based and leaves tens of millions of citizens without proper acess to health care. Under the USA system the most poerful and richest country in the world is 33rd on the international table for infant mortality rates and 38th on for life expectancy. These two facts alone indicate the failure of a complete market based system and that whatever plan is initiated it must be effiecient (which suggests some form of competition in needed) and open to all people (which means government involvement somehow and government money).
Paul Hutchinson, Calabasas, USA
Camilla Cavendish is short on positive suggestions.
Comparisons with the Germans are difficult because of cultural/public health differences.
If private practice were reasonably regulated it might be more acceptable.
Finally, some direct charges somewhere within the NHS would surely improve the fundamental rrelationship between patient and physician.
Robert, London,
Browm and Darling are Labour`s GB/AD syndrome. They
throw money at the NHS but don`t do the necessary reform out
of fear of the NHS unions. The NHS gas too much deadweight.
Too many levels of management in the wasteful socialist
style. Too many chiefs and too few Indians. Careful pruning is
needed as well as some DDT sprayed liberally on the NHS
Union parasites.
Denver Watt, Osaka, Japan
"a tax-funded free healthcare system is looking ever less sustainable":
As a nation we have a level of demand for health care of a certain standard. That level of demand has a financial cost. That financial cost will vary little whether we pay for it through taxation or private insurance.
If the private insurance route is proposed as a better option then one has to ask: 1. Who is saving the money? and 2. Who is receiving the better service?
The practical result of privatisation for the better off is that they could probably pay less in health insurance (for a better service) than they currently do in extra taxation for the NHS. Hence this article.
The effect of such an approach is that those who are worse off financially end up worse off in every respect; slighly reduced taxation but high costs (if they can afford it at all) for very basic health insurance with limited cover. But, frankly, who cares about them? Why not a two tier sysytem for a two tier society?
Luke Wilford , London,
The NHS does not need competition, it needs someone to sit down and throw out all the hangers on - the armies of managers, management consultants, accountants etc - that have blossomed like a cancer on the body of the NHS in recent years. They also need to stop pouring away billions of pounds in computer systems the front line does not need, PFI hospitals, ISTCs and white elephants like NHS direct and walk in centres.
john, sunderland,
Good article but it doesn't support at all the final conclusion: "a tax-funded free healthcare system is looking ever less sustainable. "
Indeed, the evidence suggests, that if we focus on improving productivity and quality (obvious to any competive organisation), for £90-110 billion we really could have a world class health service.
The article states that Germany has 20% fewer health care workers. It also has a population about 25% bigger, and a health care system which on personal experience I would rate 50% better.
If the health service can make the improvements implied by this, then a tax funded system is sustainable, at least for the foreseeable future.
The questions are, (1). What needs to happen to boost productivity and quality; and (2) are these feasible in a tax funded system, and (3) which political party can carry out the required changes.
Gordon Brown's policies over the last decade show that he is not fit to lead the reform of our health services.
Alex, Tunbridge Wells,
Bring back national service - everybody does a year as an auxiliary nurse. It would do wonders for the debate.
Crimean_War, Bristol,
If Bill Atkins approach were sufficient, then the more democratic changes of government as country has had, the better it would be run, and all more mature democracies would be moving towards perfection. Unfortunately, both the UK and the US show that things don't work like that. That's why it is important to actually debate the issues.
Oliver Chettle, Bedford,
Camilla is perfectly right in what she has written. Unfortunately the NHS is a bloated organisation with too many mini bureaucracies designed to provide similar, if not the same services. In context, I am referring to the multitude of PCT's which were created in the early 2000's which to micro manage the delivery of services by clinicians. The focus is all wrong. However, our politicians can not reform the health service as all rational debate goes out the window as 'Joe Public' sees the right to free healthcare as sacrosanct and any of the staff (doctors, nurses, etc) beyond reproach! Needless to say, this view is perpetuated by politicians who seek re-election.
Tim Ames, Sutton, England
Well, over 45 million Americans have NO healthcare. American hospitals--and this is fact, not fancy--have been citied for literally dumping transients on the street to suffer and possibly die, when they find the homeless can't pay their bills.
Millions of part-time workers (39 hours a week or less) have NO health insurance, because American businesses to cut costs, deny them medical insurance--or ANY benefits, because our govenment says they can.
Private health care is great--if you are making a comfortable living, or are blessed to work for government or a major corporation. However, America's health care system is badly, badly broken. As a TSR I cannot tell you the thousands of heart-breaking stories I hear, of the financial hardships--often on the elderly--our private health care system foists on millions. People lose homes, they can't afford food --they lose their lives, because of the greed of the private health insurance industry, pharmacedical companies.
Nance, Upstate, USA, NY
True - sadly - so much money and not much to show for it. I've never felt more angry than when I took my mother into hospital for cancer treatment; filthy wards, no post-op physio, no basic personal hygiene fascilities. All these things are available for private patients - using NHS doctors. The doctors, the skills are there - I think it's time we all started paying for the housekeeping and some other parts of the NHS, as you do with private schemes. The gap between NHS and private is very expensive - if only we could all pay the difference, rather than be exclusively one or the other. That might work.
madeline, york, england
Yes - the NHS may seem like a bottomless pit....but be very careful what you wish for.
Read the most important and stunning book of the year to see what the outcome could be if the private sector get their greedy claws in there. 'The Shock Doctrine' by Naomi Klein.
http://www.amazon.com/Shock-Doctrine-Rise-Disaster-Capitalism/dp/0805079831/ref=pd_bbs_sr_1/103-0751686-4189438?ie=UTF8&s=books&qid=1192199590&sr=8-1
Nick (ex-pat), Montreal, Canada
I work in the nhs,and was born and raised on it.Its founding principles are excellent,but it has been slightly ruined by the last two governments,Tories brought chronic underfunding,New Labour has brought jobs for the private sector boys and constant grinding reform,as well as unhelpful micro management.The nhs still manages to treat millions to a high standard of physical and psychiatric care.Yes it has too many managers,but so does the private sector,with marketing,commerce considerations etc.Studies from the USA show an inadequate,unfair,and in places third world system,where those areas which allow greatest profits are the most duplicated.I feel that many anti-nhs people are enemies of the universal principle,and general fairness and egalitarianism.It doesn't fit the modern world,and thats what is so great about it.
Rob, Plymouth, UK
This article is somewhat disingenuous. The ISTCs that Cavendish praises are paid over the odds, for a lower volume of less complex work. Payment By Results has caused chaos in acute care (see, for example, paediatric admissions). Such things might look nice on a management consultancy flowchart, I suppose. The private sector is happy making hay whilst the NuLab sun shines (especially via PFI).
The incidents reported in the press should make EVERYBODY take a long, hard look at themselves. Many things contribute towards somebody dying a neglected and lonely death in hospital...
Chris, Bristol,
All that I know is that the NHS has not changed one bit in 24 years (apart from the hospitals becoming even more dirty...). Tomorrow, after being over a year in considerable pain, I will once again go to a hospital, just as I did 24 years ago (following which I was finally diagnosed with endometriosis) and sit there without moving until I am seen by the consultant, because I am FED UP with being pushed from pillar to post and waiting, waiting, waiting to find out what is wrong with me, so that something can at last be done about it, rather than forcing me to swallow morphine day after day. They go on an on about waiting lists for operations, what about waiting lists for diagnosis!!!!!
Rebecca Power, Manchester, Greater Manchester
The NHS is grossly obese. It needs to lose weight, get fit, and become much more flexible. There are too many unproductive fat cells in its body. Giving it another billion or so of lard and sugar won't help.
Frank Upton, Solihull,
The NHS will go down as the major catastrophe of the 21st century. in 50 years time they'll be programmes about how it all happened and why no one did anything about it. thats a depressing thought. one thing though, if you aint got your health you got nothing. this is a rare occasion when MP's should stop this aimless bickering nonsense that usually goes on in the commons and pull their heads together to come up with an alternative. stop being stubborn labour, the NHS is in chronic meltdown. Mr cameron has a severely disabled son and if the floors arent cleaned properly and he gets ill thats when it really hits home. ministers have families and if they're not stupid they should drop their political agenda and panic like crazy to sort this mess out. or at least try!
Andrew Desborough, Liverpool,
The NHS is not quite the last of the nationalised industries. The BBC betrays exactly the same characteristics as the NHS, bloated, inefficient, dominated by producer interests and in addition permeated with an institutional arrogance. These two last dinosaurs are relics of a political and economic dead end and should be consigned to history.
Steve, Glasgow, UK
If you really wanted to improve health care remove every civil servant that is involved in operation and management of the NHS. The goverment should dictate what services its citizens should have but should never be allowed to deliver them else you end up with a department that has budget larger than most developing countries and is the largest employer in Europe.
James Fowler, Doncaster, Yorks
I think a lot of people have got the NHS wrong: it is not about treating people , but employing people.
A reward for voting Labour.
A Walton, Leicester, England
Is privatisation a panacea for the NHS.£222 million of tax payers cash was overspent on private healthcare contracts last year for work that was never carried out.The wilful waste of precious NHS funds revolves around the use of Independent Sector Treatment Centres (ISTC's) - a New Labour initiative to hive off valuable NHS work to the private sector. Not only has the policy undermined NHS hospitals but it has handed the ISTC's gold-plated contracts which mean that even if they don't do the volume of work specified they still get paid in full.The Government have been forced to admit today that the contracts with ISTC's - worth £1.4 billion - are running at 16% under capacity leaving £222 million of NHS funds being paid over to the private sector for nothing in return.
Also the a private company providing the Out of Hours GP work has recorded the highest number of complaints as it employs minimum number of doctors to provide the service thus making huge profits. There is no easy answer.
P Chabda , Portsmouth, UK/Hants
I agree with everything you say. A careful reading of the Wanless report shows that the NHS squandered its one opportunity to build its capital structure in order to use fewer workers, and instead opted to take the easy route by increasing the salaries of hospitals and physicians. Wanless himself is obviously horrified, and predicts a return to 3% annual increases in 2008, something that will by default cause NHS workers to rebel. Mr. Brown is in a hopeless position here -- his backing of a major increase in NHS funding was popular until he became PM -- just at the time the goodies for Labour/NHS are about to end. Poetic justice will arrive is the Tories take over just in time to face an outraged public.
William Boyles, Washington DC, USA
It’s ironic to find American posters decrying the NHS given the US system costs far more per head and doesn't cover the whole population. Most Europeans view the American healthcare system as disgracefully inequitable (and immorral).
Having worked in the private sector all my life, I can debunk the myth that corporations are fantastically efficient and that competition delivers excellent customer service. I also do not believe a profit motive is compatible with excellent healthcare – private providers have a vested interest in maintaining chronic ill health and private insurers have a vested interest in finding ways to exclude the most at need.
The NHS isn't perfect, but waiting lists have fallen and outcomes have improved since the extra money has gone in. It is slightly misleading to compare survival rates between the UK and central Europe given the lifestyle differences and 'Mediterranean diet'.
Will Rossetti, Bristol, UK
Just to support Ashok's comment in the face of a few banal comments. Camilla Cavendish let down a good argument with a sideways swipe at the GP contract.
GPs are paid less in real terms than they were until the 70s. They have good working conditions, but there are fewer highly-skilled professional jobs. Take law or accountancy, for example, and you will see that they are not especially well rewarded. And how many accountants or lawyers offer out-of-ours services to the general public in return for state-subsidised, lower-than-market rates?
I would say that negligence is a tricky issue. Clearly an incompetent or negligent doctor should not be licensed to practice. But medicine is at times an imprecise art, and diagnostics will never be perfect. They deserve to be protected against they petty and spiteful, fuelled by anger and frustration with their illness into launching expensive and groundless legal assaults.
John Allen, Oxford, UK
As a nurse working in the N.H.S. in Scotland I would like to know
where all the money has went.My ward has no more nursing staff
and are under greater pressure every day. I don't believe throwing the baby out with the bath water is a solution to the N.H.S. problems as a lot of good work is done by the professionals actually providing care it is structures and organizational problems and political tinkering .Also an ageing society does not help with more and more elderly frail people needing hospital care.
Those crying for a private system should realise that scheduled care can be provided from insurance policies but unscheduled emergency care is very rarely a market private firms are interested in. Anyone with an existing chronic condition will also find private care limited.
As for shock horror nurses pay rises eating up the money
we still lie beneath our police and teaching colleagues. My pension alis also contributary and I pay about £200 a month
tilda, Alexandria, Scotland
I don't see a single constructive comment here. Just whining won't change anything - in a democracy you only get what you deserve, so vote them out. If they don't get it done, vote the new lot out - eventually someone will get the message.
Incidentally, if you want to see disfunctional, wasteful healthcare just come over here.
Bill Atkins, Rehoboth Beach, USA
Camilla does well to remind us that the voracious appetite of the NHS for our taxpayers' cash is satisfied at the expense of various other deserving public services. One of these is transport. Political party leaders seldom mention it, yet it impinges on most people's lives, unless they are very unlucky healthwise, far more than the NHS. Travelling every day on an overcrowded yet expensive train, or waiting for buses delayed in traffic or cut out altogether - bad for your health? Never mind, just join the queue for the doctor or hospital - they'll fix you for free.
Barry, Wallington, UK
Having lived in three countries (Germany, Netherlands,United Kingdom, and now again Germany) I can only agree. The money spend compared to the service you get is just way out of proportion. And it is the system not the people working in the NHS. In all parts of daily life Britain is asking her people for more reponsibility of their lifes than most other European countries but health is organised like in a Stalinist regime. The outcome is a very small number of high-end, high tech pockets (Think of Sputnik) and a vast number of below the average areas (think of Lada). And like in any dictorship the people at the top end fill their own pockets. I never understood why the people of a country with such an emphasis on private responsibility and free choice support an outdated system, which is such an obvious waste of money regardless of their political background.
Mark Boss, Bremen, Germany
The NHS is the last of the nationalised industries - and just like its colleagues it is fat, bloated, inefficient and awash with vested interests. It performs at a level which would be unacceptable in any other environment but, surrounded by dogma and platitudes, it remains safe and secure from challenge.
It is high time this monstrosity - this European equivalent of the Chinese Army - was broken up.
Oh and Ashok - welcome to the real world. Most professionals have to live with the threat of legal action day in day out, of complaints by clients and the risk of challenge and investigation by regulatory authorities. Twelve hour days are the norm and, further, if we fail to make our targets we are sacked. The salaries, security of tenure and pension arrangements offered by the NHS to its doctors are unknown.
H, London,
Mike, Wilmington, it doesn't have to be this way. Other European countries have better health services than the UK and spend less on it. The USA certainly needs some kind of service. Britain could stop wasting so much money in its health system and could perhaps copy France in providing 70% coverage, the other 30% covered by private insurance.
alice, quimper, france
At the current 90billion pounds, a 60-second check on internet reveals this to be approx. 129billion euros The whole EU government, by their own 2007 budget report, has an planned income for 2007 of 115billion euros. And they want more?
KR, Stockport,
Ashok from Swansea - if your contemporaries are at university then doesn't that make you a medical student? If so, you will certainly find that you are rather more 'under the cosh' than an arts student doing 12 hours per week of organised study. When you start house jobs you may find that you do little else but work, I concede. But, neither of those positions are 'GP'. Try working the hours of a lawyer and getting an appointment with an NHS GP in the few hours of each day that they are there. It can only be done if you wait over one week and settle for an appointment at 11 o'clock! (Things might be helped if pensioners and unemployed were restricted from taking the 8 - 9 'pre-work' slots.) Inevitably, many of us end up paying £40 or so to go private (if you can wait a week then you ain't that ill, surely) - it shouldn't work like that.
Tom, Dubai,
And this is what the fools in the Democratic Pary want to bring to America. Yeah...brilliant idea, just brilliant.
Mike, Wilmington, USA
Politicians should show proper , statesman like, honest leadership regarding the NHS. They should be realistic about what can be acheived and what should be offered on the NHS- in the order of importance to life and quality of life.Anything extra and beyond this could and should be offered to those who are prepared to take out an extra private insurance.. In this way, the best of a socialist, national , same for everyone healthcare system, can be combined with the best of what private/capitalist healthcare can offer. But most of all, there should be a broad politcal consensus, and this issue should not be allowed to remain as a political football, or pin-pong game
Andrew Watson, Finchley, U.K.
perhaps camilla cavendish would like to come and shadow an av erage GP and see for herself if we are all being paid more for doing less
the majority of my contemporaries at university enjoy lifestyles more relaxed and luxurious than mine-without the constant fear and worry of complaints -negligence claims-referrals to the GMC and the challenges of helping patients in the face of increasing beuracracy and politicians who are mre interested in re-election than the long term benefits for the population
ashok , swansea,
Don't let foreign nationals use your healthcare system without making them paying for it. When I visited Caerdydd several years ago, I became ill and was seen by a physician. When I tried to pay him for his services, he stated I couldn't do so; and he refused to take any payment because he was sending the bill to your government. I feel guilty to this day about accepting such nice treatment at the British taxpayers' expense. Your taxes shouldn't potentially support all the illnesses of the world beyond your borders.
Leanna, Camden,
Hear hear. Break up the NHS into its constituent parts. A central social insurance fund into which we would all pay according to ability to pay. All hospitals should be free standing, independent organisations competing for patients. GPs would be the gatekeepers, sending patients to providers whether private or state owned which would compete on cost and ability to treat at a time that is convenient. We have to be more realistic about what should and should not be available free on the NHS.
Simply pouring money into this monolith is not working and has been shown not to work. It has created a huge bureaucracy with productivity and customer service that would bankrupt any business. It is time to call a halt and design a new system from the bottom up before it bankrupts us all. If we have learnt this these last ten years then it may be new Labour's one lasting legacy.
Paul Owen, Birmingham, UK
Good article. What new labour wanted to use as the golden hen for laying thousands of more golden votes for them could now prove their nemesis. Middle england wont put up with such gargantuan waste that is the nhs especially since their disposable incomes are already being stealthily eroded.
It was interesting to hear a doctor on radio 5live last week whilst debating the use of unlicensed cancer drugs stating that he didnt ask or need a huge pay rise he had been given on a plate from new labour, he was already on an excellent salary.
The tide is turning, new labour had a chance to make hay whilst the sun shone, instead they opted to make not so enviromentally friendly crops to make bio-fuels, and now the greyer skies are gathering overhead and there's nothing they can do about it.
rolly, aberdeen,