The Doctors for Reform study published yesterday argues - through the use of only 20 case studies - that more patients are paying 'top-up' fees and that 'the fundamental NHS principle - that care should be universally and equitably available ' no longer applies'.

The Doctors for Reform study published yesterday argues - through the use of only 20 case studies - that more patients are paying 'top-up' fees and that 'the fundamental NHS principle - that care should be universally and equitably available ' no longer applies'.

The debate the report's authors wish to begin is on patients paying 'top-up' fees for healthcare. The notion that equality of access may be improved by encouraging and sanctioning the development of a multi-tier health service - with better care the more you can pay - is a dangerous one to promote. The only way equal access to healthcare will be achieved is if such a vital service is universal and free. The authoritative 2002 Wanless report found that general taxation was the most equitable and efficient way of funding the NHS, not the use of 'top-up' fees. This is the current starting point for any debate on the NHS, and it should remain so.

Kevin Coyne, national officer for health, Amicus

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