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

Sir: Labour's hands will not be tied, as Jack O'Sullivan suggests ("Is the NHS safe under Dr Blair's team?", 30 October), if it refuses to pledge new funds for the National Health Service.

Money cannot solve the current problems of the NHS, which are largely a consequence of the Conservative government's ill-judged efforts to turn it into a giant supermarket. These "reforms" fragmented the service, increased transaction costs, dealt a terrible blow to staff morale and undermined public confidence.

The Institute for Public Policy Research report "New Agenda for Health" shows how much can be done without spending new money. It includes detailed proposals on how to abolish the internal market, how to make strides towards improving health, not just curing illness, how to establish an equitable basis for rationing, how to tackle the democratic deficit and how to position the NHS to take advantage of technological change in the next decade.

We also argue that if more public money were available, it would be better spent on education, jobs, housing and other such measures which really do help to improve the health of the nation as a whole.

ANNA COOTE

Deputy Director, IPPR

London WC2