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EDUCATION AND DEBATE: Chris Ham Money can't buy you satisfaction BMJ 2005; 330: 597-599 [Full text]

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Picking cherries

Mark Struthers   (13 March 2005)

Can the principles of the NHS be maintained?

Michael A Williams, Tanya Moutray   (14 March 2005)

Picking cherries 13 March 2005
Mark Struthers, GP Bedfordshire, UK. mark.struthers@which.net Send response to journal: Re: Picking cherries	How do we know that policy makers in successive British governments are actually picking cherries from the United States? If Britain is not to acquire a poisoned fruit, the values and politics of those picking cherries may make a lot of difference. Who are the cherry pickers? ‘Ignis aurum probat, miseria fortes viros.’ ‘Life is not a bowl of cherries’ Competing interests: None declared
Can the principles of the NHS be maintained? 14 March 2005
Michael A Williams, Specialist Registrar, Ophthalmology Royal Victoria Hospital, Belfast, BT12 6BA, Tanya Moutray Send response to journal: Re: Can the principles of the NHS be maintained?	In the United States a radical transformation of health financing may indeed be impossible because of Americans’ attitudes. It is said that American society is more right wing than British society. For example across the pond there is great value put on personal freedom, a capitalist system of commerce, and consistent support for the death penalty, the right to bear arms and, even before ‘9-11’, a strong national defence. Government intrusion into individuals' lives, in the form of higher taxation, is less tolerated than in the UK both for personal financial reasons but also on moral grounds. There is an almost religious belief in small government. Attitudes in the UK to health service financing are different but are as deeply held. Consumers of the NHS have a strongly held belief that the product; health care, should be funded through general taxation, free at the point of access and equally accessible to all. Even the Thatcher government, whose ethos was closer than most to any US administration, was reluctant to fundamentally restructure NHS financing. British governments appreciate the adherence of their electorate to the principles of the NHS. However the British general public are myopic. This is reflected in their desire for more NHS staff and more local and high level facilities and their unwillingness to pay higher taxes. The Liberal Democrats find this out every time they advocate higher taxes and fail to break through from ‘third place’ in General Elections, despite their likeable image as a political party. In general a free market is good for consumers. It forces providers to minimise the price and maximise the quality of their product, whether the product be a car, toothpaste or insurance. The NHS is different. However there will come a time, perhaps it is here, when the present method of NHS funding can no longer keep up with an ageing population which demands quicker and more sophisticated health care. Fundamental changes may be needed. Whether cherry picking initiatives from the US health care system is actually dismantling the principles of the NHS by stealth is a matter for debate. How much a role the medical profession should have in defending the NHS as it is, or encouraging change, is another matter for debate. There is nothing wrong or old fashioned about believing in the NHS. It is a system the medical profession should be proud of, and we should defend its principles. The challenge lies in being pragmatic; accepting the need for American style changes to allow the NHS to meet the needs and demands of consumers while trying not to compromise its equitable ethos. Competing interests: None declared