Intended for healthcare professionals

Rapid response to:

Letters Why medicine is overweight

Don’t forget inconvenient truth of supplier induced demand

BMJ 2010; 340 doi: (Published 23 June 2010) Cite this as: BMJ 2010;340:c3334

Rapid Response:

Deficit reducing options based on values

Although I agree with Richard Smith that increased healthcare supply
can increase demand for healthcare service, I strongly disagree with his
suggestion that all those earning over £20,000 a year in the NHS should
have their salaries cut by 5 or 10%. I would be surprised if anyone
earning at, or near, this lower limit would have any sympathy with it.
Although I accept the need to make changes in national consumption in
order to tackle a current deficit and increasing debt, there are choices
on how this can be done, which are made according to our value system.

NHS workers earning at, or near, this limit will be varied in their
circumstances (e.g. main household earner, sole household earner, single
parent, single person living with parents), however, I would argue that at
a time when the cost of basic necessities such as food, housing and fuel
are ever-increasing, most of these individuals, already earning less than
the average income, will struggle to make ends meet with the loss of £2000
or even £1000 of their annual income.

I propose that progressive taxation, or legislation to narrow the
sadly increasing gap between the highest and lowest paid, are alternative
options, which would contribute more equitably to rebalancing our public
finances. Further to this, if the aim is to decrease supplier induced
demand of healthcare services of ‘dubious’ efficacy, could we not re-
orient talent and increase capacity in health improvement work, thereby
garnering the additional long-term economic gains this would provide?

Competing interests:
None declared

Competing interests: No competing interests

05 July 2010
Sonya Scott
StR in Public Health