Letter: NHS charges

Sir: The debate on health service charges can be expected to warm up as government departments move deeper into the spending estimates round

Charges have been a small part of the NHS since it was founded. None the less they still form a very small part of NHS income (2.3 per cent in 1996). Increasing charges won't help cut waiting lists or fund pay increases for NHS staff.

They are not, however, imposed to raise money. Since the Marshall Plan in the 1940s, through the IMF in the 1960s to the present, they have had the two aims of impressing bankers with the Government's commitment to austerity and discouraging demand.

Charges aren't just a tax on the sick, they are particularly perverse one. They are generally levied on primary care: the cheapest, most cost- effective form of diagnosis and early intervention. Putting people off going to the GP, the dentist or the optician simply makes the crisis in hospitals even worse.

If the public want more and better health services, there are ways which would which require action on many levels: tackling poverty and poor housing; a coherent strategy for fluoridation of water; lifting the pressures which lead individuals to smoke, drink alcohol to excess and have poor diets; channelling pharmaceutical industry profits into the areas of research and education which the NHS prioritises; and tackling waste in the NHS , such as in supplies and computing.

JOHN EVERSLEY

Senior Research Fellow

Public Policy Research Unit

Queen Mary and Westfield College

University of London