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Rapid response to:


Rhetoric about NHS reform is misplaced

BMJ 2023; 380 doi: (Published 11 January 2023) Cite this as: BMJ 2023;380:p54

Rapid Response:

Re: Rhetoric about NHS reform is misplaced

Dear Editor

BMJ 2023;380:p54

In his 14 Jan 2023 editorial “Rhetoric about NHS reform is misplaced”, Hugh Alderwick is right to dismiss Sajid Javid’s suggestion that the government “looks at alternative ways of funding the health service, like social insurance”. That the NHS is not delivering enough healthcare is shown clearly by the huge waiting lists for elective surgery and for psychiatric treatment, and by the extraordinary numbers of patients who wait dangerously long periods in ambulances backed up outside overwhelmed accident and emergency departments.

Meaningful improvements in NHS performance (“catching up”) will mean more episodes of treatment, which will require more resources, including more staff, and thus more expenditure than at present. Moving away from the efficient model of funding healthcare from taxation at a time when medical activity has to increase will require very large amounts of expenditure by individuals not only in fee-for-service payments but also premiums for the insurance market which would have to develop to give people some protection from the shattering costs of the medical care they are so likely to incur on and off through their lives.

Overall, the combined total cost of medical interventions, to the UK as a whole, would increase, while at the same time disease processes would present at more advanced stages, as people sought to put off starting treatment for which they could expect to have to take personal financial responsibility.

The greater the element of private payment in meeting the UK’s health needs, the greater the total cost to the nation, and hence the greater the diversion of potential funding from the vital task of modernising the UK’s economy to keep us competitive with other developed nations. I should have thought that the Conservative right should have been able to see this….

Yours sincerely

James Barbour (retired GP)

P.S. Would you consider tasking a special editor explicitly to check sentences with numbers in them? Hugh Alderwick’s point that the health service in the UK is seriously underfunded is somewhat obscured by the scrambling of the third sentence in the section of his editorial headed “spending choices”; I presume the “£40bn higher every year” is actually the addition to the UK total health expenditure if the UK were to increase its per capita health spend to the EU14 average.

Competing interests: No competing interests

06 February 2023
James V Barbour
retired GP
none in recent years