Sir: Your leading article of 25 August ('More is not always better') on the subject of NHS funding or, rather, underfunding may have left your readers misinformed. The Office of Health Economics (OHE) report states that 6.1 per cent of GDP in the UK is spent on health. This is significantly less than our peer nations. By all means let us be efficient but let us not excuse failure to fund adequately on false assumptions about efficiency.

The NHS has suffered about seven years of so-called 1 per cent recurrent efficiency savings on top of underfunded inflation and pay awards. Initially the service made savings on cleaning bills and food and later closed wards and laid off nursing staff.

Acute hospitals are currently unable to offer new treatments without stopping doing something else. If the hospital's deficit looks significant, wards are closed and patients rushed through the remaining beds faster. Money is not following the patients. From my experience more patients are being treated but some health authorities are refusing to pay up.

Unemployment and poverty are increasing in 1992. There is a direct relationship between unemployment as an indicator of socio- economic deprivation and hospital admissions. Greater numbers of hospital beds and longer lengths of stay could have a common cause in increased medical need related to poverty as described in the Black Report.

The Office of Health Economics report also highlighted the relatively high infant mortality rate in the UK in relation to comparable nations, and this is a key indicator of medical welfare. The other interesting feature is that spending on private health is rising three times as fast as NHS


Yours faithfully,



West Midlands

27 August