Leading Article: If the NHS is to get better, we must involve the private sector

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FIFTY YEARS after the creation of the National Health Service, we still feel a collective glow of pride at our creation. That pride is still justified. It is time, however, to start a serious debate on modernising the NHS to the standards that other countries in Europe already take for granted. And we must accept that private health care will have a key role to play.

The interlocking relationship between the NHS and private health schemes is deeply uneasy, as illustrated by the Norwich Union scheme that has caused a storm by offering patients pounds 250 a day to occupy NHS beds. This raises unsettling questions about the relationship between private and state-funded health care.

The private sector is elsewhere making incursions on to the state. So why not in medicine? A College of Health report published yesterday emphasises the extent of the challenge before the health service. Some patients are waiting four years to see a specialist. Long waits are now seen as par for the course. The Government has embarked on patient-friendly reforms, including league tables, walk-in centres and easier access to NHS care. But a simple truth remains: the performance of our National Health Service is not what its patients would wish it to be.

The NHS stands in our minds as a symbol of the post-war breach with the divided society that Britain was until then. For the first time, everybody was entitled to a decent standard of health care. The contrast with what came before was obvious and stark; any criticism of the health service was perceived as breaking an unbreakable taboo. We do not, however, need to hark back to pre-war Britain to make realistic assessments.

Our immediate European neighbours enjoy levels of health care that for Britons remain the stuff of fantasy. Patients are seen quickly if they visit the doctor, and necessary operations are carried out promptly. France, Germany, and other EU countries have differing approaches to the financing of the health care system. But all share the basic assumption that while patients are not expected to dip into their own pockets, long waiting times are unthinkable. Stories about the NHS queues in Britain are met with frank expressions of disbelief.

This is partly a question of money. As a proportion of GDP, Britain spends less on health than most countries in Europe - though the Labour Government has committed itself to pounds 21bn of new investment over the next three years. But it is not just a question of money, it is also a question of expectations. Even now, the widespread attitude is that we should consider ourselves lucky that the NHS exists at all.

Patients must start to be better informed, expect more and be prepared to argue their corner with the experts. Alongside this, we must start to examine more radical reform of the way that the health service is financed - thinking the unthinkable, to use the now-familiar phrase, is essential. A refusal to change will bring the worst of all worlds.

Private health care is already here to stay. It must be better regulated, provide improved services and target them more cleverly. Market forces - in other words, sheer cost - will stop it supplanting the core provisions of the state sector. In the meantime, if the service is to get better we must stop believing that existing structures are sacrosanct.