Letter : Rationing health care: politicians should not be afraid to let the people decide

Sir: Since the health service reforms there has been a complete lack of central strategic planning, the philosophy being to allow NHS trusts to battle it out in a market-forces war.

If the public do not want to pay more for their health service, then a severe rationalisation of the number of specialists within hospitals and of hospitals within regions has to take place. But it must be properly managed, otherwise patients suffer and staff become demoralised.

If on the other hand tax-payers do want more spent, rather than seeing hospitals closed down, then the politicians have a responsibility to do this. Of course, cost effectiveness and efficiency must be part of the bargain, and the secrecy that has surrounded both purchasers and providers since the internal market began should be stopped. It should be remembered, however, that overall the NHS still delivers the least expensive quality services amongst the developed nations.

When Jack O'Sullivan suggests we may need fewer doctors, the comparison with the USA is misleading. The UK has 61per cent fewer doctors per 1,000 population than the USA already, so the latter can afford to reduce their doctors by 25per cent and still have more than we have. France, with the same population as ourselves, has twice as many doctors and 65 per cent more beds (OECD Health Data).

PETER M BROWN FRCS

Clinical Director, Head & Neck Specialities

Milton Keynes General NHS Trust

Milton Keynes, Buckinghamshire