London Review of Books 45 (2023), 8

Alice Spawls writes about the diminution and degradation of NHS services (LRB, 30 March). As a GP I meet patients almost daily who have been obliged to seek private treatment. They are often rueful about the cost, and say that they’d rather pay a little more in tax than spend tens of thousands of pounds of savings.

David Runciman, in the same issue, notes that mixed-payment, insurance-based health services such as those in France and Australia have better outcomes than the NHS, and thinks we should probably do more of what they do, i.e. make use of insurance companies to fund healthcare, rather than rely solely on general taxation. Runciman suggests that the NHS is too ‘sacrosanct’ for politicians to meddle with, but the truth is they meddle with it all the time. I’d argue that what is sacrosanct isn’t the service itself, but the principle of paying for it through general taxation rather than insurance, add-ons and top-up fees.

The solution to the NHS’s current problems is quite straightforward: fund it properly. If any political party wishes that funding to be supplied via insurance and add-on payments rather than taxation then so be it; they should put it in their manifesto and let us vote on it. That might make it ‘hard for politicians to get elected’, as Runciman puts it, but isn’t that the point of democracy? The NHS is in a dire state, worse than I’ve known it since the mid-1990s. If the government doesn’t want to fund the service to the standard that the electorate wants, then perhaps it’s time to make way for a group of MPs who will.