Intended for healthcare professionals

Rapid response to:

News Roundup [abridged Versions Appear In The Paper Journal]

Reform group calls for shake up in NHS funding

BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:813

Rapid Response:

Re: NHS funding

Maybe these people are more interested in meeting the needs
of the insured few, and not everyone ?   In his most readable paper the far-sighted Nye
Bevan rejected National Insurance , and Private Insurance , thus:-


When I was
engaged in formulating the main principles of the British Health Service, I had
to give careful study to various proposals for financing it, and as this aspect
of the scheme is a matter of anxious discussion in many other parts of the
world, it may be useful if I set down the main considerations that guided my
choice. In the first place, what was to be its financial relationship with
national insurance; should the health service be on an insurance basis? I
decided against this. It had always seemed to me that a personal contributory
basis was peculiarly inappropriate to a national health service. There is, for
example, the question of the qualifying period. That is to say, so many
contributions for this benefit, and so many more for additional benefits, until
enough contributions are eventually paid to qualify the contributor for the
full range of benefits.In the case of health treatment this would give rise to
endless anomalies, quite apart from the administrative jungle which would pe
created. This is already the case in countries where people insure privately
for operations as distinct from hospital or vice versa.

may be said for it in private insurance, it would be out of place in a national
scheme. Imagine a patient lying in hospital after an operation and ruefully
reflecting that if the operation had been delayed another month he would have
qualified for the operation benefit. Limited benefits for limited contributions
ignore the overriding consideration that the full range of health machinery
must be there in any case, independent of the patient's right of free access to
it. Where a patient claimed he could not afford treatment, an investigation
would have to be made into his means, with all the personal humiliation and
vexation involved. This scarcely provides the relaxed mental condition needed
for a quick and full recovery. Of course there is always the right to refuse
treatment to a person who cannot afford it. You can always 'pass by on the
other side'. That may be sound economics. It could not be worse morals.


Extract from
In Place of Fear: A Free
Health Service
, by Aneurin Bevan, 1952

Competing interests:
NHS-contracted GP

Competing interests: Maybe these people are more interested in meeting the needsof the insured few, and not everyone ?

09 April 2006
L S Lewis
Surgery, Newport, Pembrokeshire, SA42 0TJ