Letter: Acute need to avoid a two-tier NHS

Sir: Rodney Walker, retiring chairman of the NHS Trust Federation, seems to have stirred up a hornet's nest with his predictions of impending difficulties in financing health care ("NHS 'to decline into safety net for old' ", 16 September).

The immediate Government reaction that he is being much too gloomy is probably correct, but only if the decision is taken to release the NHS from the wasteful and inappropriate market system under which it now struggles. Both the Audit Commission and our own recent publication on the subject have demonstrated the enormous savings which could be made and redirected into patient care.

To be fair to Mr Walker, there will still be a need for some additional health spending to keep pace with medical developments and the increasing number of very elderly people. His view that those who can afford it should make an additional contribution is perfectly reasonable. Where he goes astray is in suggesting that this should be by taking out private health insurance. All this would achieve would be a two-tier system, contrary to the principles of the NHS and the wishes of the vast majority of the population.

There is a much fairer and more accurate system of ensuring that all contribute according to their means to a service which bases priority on medical need. This, of course, is direct taxation, something from which politicians now seem to recoil in horror as they try to outbid each other as tax cutters. It is, however, a nettle they are going to have to grasp, and who knows, they might even find the electorate responds positively to a little frankness.

Yours faithfully,

Peter Fisher

Chairman

National Health Service

Consultants' Association

Great Bourton, Oxfordshire

16 September

17 September