A distinguished doctor tells the truth about the sickly state of the NHS

He may be the high priest of one of Britain's more powerful vested interests, but Sir Anthony Grabham, the new president of the British Medical Association, speaks with some authority on the parlous state of the National Health Service. In his inaugural address at the BMA conference, Sir Anthony seemed to get things about right when he talked about an NHS of "thirds", with one third providing care of the highest quality, another third delivering reasonably good provision, but the last third – an uncomfortably high proportion – being of "third world" quality.

It is a picture that regular users of the service will recognise much more readily than that often presented by the Government's spin machine. But even the most partisan of special advisers and government ministers have been forced to admit that in many cases the NHS is, indeed, failing its patients badly. There is certainly a growing consensus that Britain lags behind other advanced societies in many aspects of health care, from cancer survival rates to the use of information technology. The Treasury-commissioned Wanless report set out in lengthy detail the shortcomings of the NHS for patients and staff alike.

The debate, of course, is about how to remedy these ills and ensure the NHS has the resources it needs and the systems and organisation to use its funding efficiently. Since the Budget we are at least clear about the Government's response to the problem; raising taxes to pay for improvements within a modernised and reformed service. No doubt this general approach will be conformed to in the forthcoming Comprehensive Spending Review. Many of the reforms detailed in the NHS 10-year plan are welcome and will devolve decision-making in the NHS, improve patient and GP choice and make the old command structure a little more flexible. Alan Milburn, the Secretary of State for Health, is to be congratulated, for example, on using European facilities to cut waiting times.

That said, however, the fundamental problem with the Government's approach remains the adamantine refusal of the Chancellor to consider alternative methods of funding the NHS. This seems especially stubborn when our European neighbours' healthcare systems enjoy much higher standards of care, and not always with vastly greater amounts spent on them. The difference seems to be that in many of these countries the system of funding for health care is used to stimulate competition and encourage user choice. The Conservatives have a good deal to live down when it comes to heath care, but at least in their peregrinations around Europe they have shown a willingness to find out precisely why sick Swedes, say, are better cared for than we are.

Recently there have been some indications that the Government may be starting to think again about its abolition of the internal market introduced by the Conservatives 15 years ago, the nearest Britain ever got to the principle of money following the patient, but the thrust of policy remains unclear.

The public can only hope, then, that the Government and, particularly, the Chancellor listen when as distinguished and committed a physician as Sir Anthony declares that "after 50 years of underfunding it seems reasonable at least to consider the alternatives – particularly in those countries where the health services clearly work better than the NHS". But we know Gordon Brown and we know how stubborn he can be. Sadly, it will take more than the BMA to change his mind.