Your comments regarding the latest re-structuring and the need instead for a serious consideration of a new approach to funding struck a note of clarity, at long last, in the debate about how best to make the NHS more efficient and effective.1 I have spent most of my working life under the aegis of the NHS in Northern Ireland, but have many family members in the Republic of Ireland, and while its system of health care has its own problems, the insurance-based funding ensures that both consumers (patients) and providers (health professionals) are made very aware of the actual costs of treatment. The patients may (and often do) obtain reimbursement but the message is clear. I acknowledge that there are significant transactional costs in such schemes but until we can depart from the Holy Grail of a comprehensive ‘cradle to grave’ service, also ‘free at the point of use’, no amount of restructuring will address the need for all parties in the NHS to use the service in the most effective way. I hope sincerely that your excellent article is read by those in the medico–political arena, the NHS as it stands is indeed both uncontrollable and now unaffordable.
- © British Journal of General Practice, 2010.
