An insurance-based health system would give power back to patients

SIR – Interesting and encouraging though Sir Keir Starmer’s article was (“The NHS is not an out-of-bounds shrine. It needs unsentimental reform”, Comment, January 15), it misses the real reason for NHS failure.

“Free at the point of use” means that we consumers are beneficiaries of charity. We are expected to be deeply grateful for what the NHS is able, willing or prepared to provide, and not demand more. That opens the door to lack of accountability and consequent bureaucratic inefficiency.

Reforming universal health care in Britain through insurance, with the less advantaged subsidised but most of us paying our fair share, would put us in a contractual, not charitable, relationship with our health provider, and make us able to call the shots if we do not receive what we pay for.

Rev His Honour Peter Morrell Nassington, Northamptonshire

SIR – I read with interest Allister Heath’s article (Comment, January 12) suggesting that the NHS is “dead”. That this should be possible is morally unacceptable. The health service must be saved, but needs rebuilding from its very foundations as rapidly as possible.

In post-war Britain, Aneurin Bevan introduced a radical, free-at-point-ofuse NHS, based on a small, successful service in a Welsh town that had employed five doctors, with its tiny hospital funded by payments made by the local community. In nationalising Britain’s hospitals and health services, Bevan expanded this modest scheme into a nationwide one, ignoring a better system in Canada known as Swift Current Health Region Number One, which now provides the country with its state-funded health service. The system is superior as it has in-built financial deterrents against overuse.

Unfortunately, Bevan’s chief concern was political. He wished to demonstrate to the British public how the Labour Party could speedily deliver on its election promises. In so doing he introduced the seeds of the NHS’S decline by creating a grossly underfunded and under-resourced service, while at the same time making it a political football.

Having worked as a doctor in Canada and Britain, I have personal experience of both systems. Dr Arnold Powell London N2

SIR – I am suspicious of did-not-attend (DNA) statistics quoted by the NHS (“NHS waste is inevitable when everyone thinks it’s free”, Comment, January 14). I once cancelled an outpatient appointment in advance by telephone. The day after the appointment I received a call from an irate member of staff querying my non-attendance. I said that I had cancelled and was asked what contact number I used. When I replied that I had used the cancellation number specifically included in the confirmatory text message, I was told that I had used the wrong number.

A DNA mark remains on my medical record to this day. Anthony Gales Henham, Essex