The BMA, Unison and others (letter, April 27) are right that the NHS needs to improve “efficiency and responsiveness” but are wrong to say that “funding through tax ensures equity for patients”. The 1945 model of healthcare has never delivered fairness. The NHS does not deliver the same level of care for the poorest people as for the middle classes. Continental health systems do deliver that level of fairness.

No leading organisation — certainly not Doctors for Reform — is arguing for American-style private insurance where some people go without health cover. Continental health systems, such as those in France, Germany and Switzerland, guarantee access to care at higher standards and without any waiting lists. The London School of Economics has shown that these advantages are achieved with barely any increase in bureaucracy.

While the taxpayer can guarantee access, it is not honest to say that taxpayers’ resources are meeting rising patient needs today, nor is it realistic to say that they will do so tomorrow. A mixed funding system with other sources of finance, equitably raised, would allow the gaps in today’s NHS service to be filled and a modern, truly comprehensive service to emerge.

JIM THORNTON
Professor of Obstetrics and Gynaecology
Doctors for Reform
London SW1

Sir, Operating costs in the NHS will continue to rise. While the present crisis is inappropriately attributed to staff salaries and the recent increases made to them, barely contingent upon the rising cost of living, there is no mention of the massive capital expenditure on advanced diagnostic equipment, magnetic resonance imaging (MRI scanning) being but one relatively recent example.

The NHS is far better value for money than any private health insurance scheme, most notably in the field of malignant disease, which involves, and will involve, one third of the population. This is a clinical field which the private health insurers prefer to avoid.

J. P. WALSH
Chingford, Essex

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