Published: 20/12/2001, Volume III, No.5786 Page 22 23
Bringing NHS funding up to the average European level could cost an extra£15bn a year, equivalent to 5p on the standard rate of income tax.
Some of this could be transferred to higher-rate taxpayers. Raising it through stealth taxes could hit people who cannot afford to pay.
More dependence on the private sector has fatal objections. Private care is more expensive. The private sector is small and competes for scarce manpower with the NHS.
From experience of the Dutch and German systems, I admit they have advantages. One is that the true cost of healthcare is more widely known.
Competition and choice may increase cost-effectiveness and user satisfaction. As private insurers receive subsidies for expensive patients, these systems are not comparable with British private insurance schemes. Insurers can't refuse applicants or terminate cover for the chronically ill. Those who can't afford the premiums are catered for in other ways but not treated differently. In the Netherlands, only a hospital accounts department knew how I was insured.
The NHS needs structural reform. No state-funded system can provide everything that anybody demands. Hard decisions on how to use scarce resources need to be taken and are bound to be unpopular with some. Without such decisions, we are in danger of not being able to provide basic care because we will have spent too much on experimental procedures unlikely to achieve much. Some research is to be encouraged, but it must not be confused with basic care.
Contracts of employment that create perverse incentives must go, which could also mean reforming pay structures.
The argument that extra funding must not be provided until things have improved is a 'Catch 22'. Striving for greater efficiency can never be an alternative to adequate funding. Even massive funding increases could fail to produce rapid enough improvement to satisfy many. You cannot train specialists overnight. Backlogs of building repairs, training and replacing out-of-date equipment will take time to resolve. The problems will not vanish as soon as funding issues are addressed. Politicians need to be honest and resolute to weather the storm of criticism when tax rises do not produce immediate benefits.
For about the first time since the NHS was born, I think that there is some chance of this.
Councillor John C Murphy Feltham Middlesex