Description

Once more the National Health Service is in the headlines for all the wrong reasons. The Labour administration have apparently decided that much more money is needed to correct systemic shortfalls and that general taxation may rise. The Health secretary agrees that more doctors, nurses, beds etc. are essential and on the face of it, appears to have persuaded his Cabinet colleagues.

Unfortunately the Chancellor has ideas which conflict with the Health secretary and with many serious commentators. He agrees more money is required but wants evidence of more efficiency before it is released. He also flatly rejects an earmarked tax (hypothecation) as unworkable. One wonders if this is because that would diminish his influence on the annual / 3 yearly spending round. His stated desire to see more efficiency is also strange. By most standards the National health service is incredibly efficient, delivering an awful lot of healthcare for a fairly modest financial outlay.

Herein lies the main problem: the financial aspects of UK healthcare have always taken precedence over anything else and will continue to do so as long as the dead hand of the Treasury is in control. Financial efficiency does not equate with high quality effectiveness even though this is the desire of the public. More doctors (probably a doubling of numbers) more nurses and beds, more scientific staff etc. are unlikely in a system controlled by the centre. The marketplace has delivered different models in advanced countries around the world and none are as depressing for the average patient as that in this country. Even the much derided US model actually delivers more state spending as a proportion of GDP than the UK.

Otolaryngologists have a duty to speak out about these problems as our patients are amongst those who suffer most in terms of inadequate facilities and restricted access. Our specialty has never enjoyed a high profile in the national picture and – despite recent initiatives such as Action on ENT – will probably never reach the levels that the public demand. Even the General Medical Council do not make it a compulsory subject for undergraduates although half of them will need it badly in general practice.

We urge all readers of this journal to involve themselves with their patients and the general public in the forthcoming debate. Otherwise we may have to live for many years with decisions made by the uninformed.