Overhauling the NHS
SIR – Having worked for 37 years in the NHS, I was and remain committed to the idea of treatment free at the time of need.
However, the economic model on which the NHS is based is broken, and no political party can admit that.
We therefore need a Royal Commission to consider how we can rescue the situation (Leading article, January 12). Nothing should be off the table, short of total privatisation.
Changes might include limiting conditions the NHS should treat; excluding surgical procedures of marginal benefit to the patient; introducing charges for GP visits; and encouraging private insurance to offer lower-cost schemes covering procedures the NHS no longer offers.
I am advocating none of these changes, but they must be considered alongside more drastic options.
There are other problems to consider, including the shortage of beds in the hospital sector, the shortage of trained staff and the lack of care in the community. The root of all these problems is money, but the solution need not mean more expense.
For example, combining hospital and social care budgets would get more money flowing to the community and allow for the care of elderly patients, more humanely and at lower cost, in their own homes.
Unless we face and try to solve these problems, I believe the NHS will cease to provide a service the public will accept as adequate. Dr David Wise
Wantage, Oxfordshire
SIR – The Centre for Policy Studies suggests introducing performancerelated pay to help improve the NHS (report, January 8).
This would add even more bureaucracy to that created by the internal market. More importantly, however, it would concentrate minds on those items that can be counted, to the detriment of those that matter but cannot. The NHS is a service, not a manufacturing industry. Dr John Garside
Thirsk, North Yorkshire
SIR – The proposal to rename National Insurance as National Health Insurance and use it to fund the NHS is nothing new (Letters, January 12).
In the Fifties, when National Insurance contributions were recorded with special stamps, the stamp stated “includes 1s 8d national health”. The Treasury soon scuppered that and would do so again. George Langton
Southsea, Hampshire