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EDITORIALS: Ray Robinson Gold for the NHS BMJ 2002; 324: 987-988 [Full text]

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What exactly is being bought with this gold?

Peter Davies   (30 April 2002)

What exactly is being bought with this gold? 30 April 2002
Peter Davies, GP Mixenden Stones Surgery,Halifax,HX2 8RQ Send response to journal: Re: What exactly is being bought with this gold?	Sir, I read this article (1) and two concerns came into my mind and I would like to share them with colleagues. My first concern is about what exactly is the government buying with all the extra billions it is spending on the NHS? Is it hoping to buy more medical treatment on behalf of the public? Is it hoping to make the population healthier by so doing? (2) If it is the first of these it has some hope of achieving its aims, although it is not clear where the extra staff are going to be brought from. If it is hoping to make a difference to the overall health of the public by spending through the NHS system it is mistaken. Any illness treatment system such as the NHS can only deal with the casualties of life, not with how to live healthily in the first place.(3) This brings me on to my second concern that simply concentrating on supply side measures will pander to medical vanity (treatment as all important)and move thinking away from looking at how and why demand for medical services arises in the first place. Unless we as individuals and as a society are able to encompass the full picture of health, including its environmental factors, its social relationships and its political and moral dynamics we will continue to find health puzzling and frustrating. We must start to examine the sources of demand for health care and learn to modify these before they reach the level of detectable diseases at our surgeries and clinics.This will require courageous medicine, and courageous politics but the price of not doing it will be so great that it will be heartbreaking for politicians and the public. Refs 1. Gold for the NHS, Robinson,R BMJ 2002 324:987-8 2. NHS to receive an extra £40bn over next five years. Moore,W BMJ News 2002 324:993 3. The Big Picture of Health. Davies,P Caduceus No55 Spring 2002 (accessible at http://www.neurosemantics.com/articles/The_Big_Picture_of_Health.htm)