LETTERS Health reform
Sir: Amid the constant barrage of near hysterical demands via the media for more cash to bolster the hard-pressed National Health Service a glimmer of truth and reality is at last beginning to intrude.
There have recently been two contrast- ing articles on the subject in your journal. The first a paean of emotional nonsense by Miss Alexandra Artley which entirely mis- ses the point (`Our medical heritage', 12 December). The real value of services provided by the NHS has been due to the dedication of doctors, nurses, technicians and auxiliary workers in this country, as indeed it was for years before the advent of the NHS and has very little to do with the existence of the NHS. It might even have been better without it!
By contrast the second is a most salutary and illuminating article by Dr Myles Harris who paints his picture with the ring of truth and exasperation (National health or national disease', 9 January).
I myself have practised as a surgeon with the NHS in London for the past 38 years. Financial constraints have always been with us, although admittedly now becom- ing worse. But the real worry has been a progressive deterioration in the standards of management and administration gov- erning what has always been an unwieldy and inflexibly bureaucratic structure. In- efficiency, waste and incompetence are the real enemies. Throwing our money at such a monster is no proper solution and only compounds the problem. Much the same conclusion was also reached by yourself when speaking on the BBC Any Ques- tions? panel on Friday, 8 January.
There can only be one answer to all this public distress. A new Act of Parliament setting up a board of health commissioners with a non-political chairman and elected members who govern an administration separate from the Civil Service.
It must be fully accountable in perform- ance and sound financial discipline. Annual block grants of cash from the Government should be supplemented by a social health insurance scheme and by active collaboration with private sector health and commercial organisations. Other fund-raising options should also be explored with an emphasis on local and regional initiatives. Clear priorities of health care for the service must be con- firmed and regularly reviewed.
If nothing effective is done by politicians to detach and re-organise the NHS along some such lines it will sadly remain a fraudulent political football and a likely albatross for the Conservatives at the next general election.
Henry Jagoe Shaw,
106 Harley Street, London W1
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