Polly Toynbee illuminates so well how the Tories and the right-wing press are seeking to undermine the NHS (NHS destroyers can’t accept the British public still support it, 27 June). We have seen this happen with all our other public services, where funding has been cut below the required level and then privatization is seen as the savior, with investment and the kind of business management that is focused on cutting wages and increasing profits. This approach began with the adoption of the Griffiths report in the 1980s and the reduction of clinical leadership.
The profits from such privatization would then be siphoned out of the service and go to inflate bonuses for those at the top and pay dividends to shareholders. A further result is that those who work in the service are often seen as commodities and chattels to be sold to the highest bidder, and the fundamental ethos of public service is diminished.
We will also see services become fragmented as companies look to absorb those in areas where profitability will be assured. It must be concluded that this will not include areas of the country where deprivation is highest. Inequalities in health care will increase further.
I’m not sure what Nye Bevan would now call those who seek to destroy the NHS that he and others passionately advocated in the 1940s. His use of the term “parasites” to describe the Tori may be a bit dated, and perhaps one that reflects their current nature might be more appropriate, such as “hyena” or “vulture”. Dr Peter Wimpenny Great Sand, Highland
Polly Toynbee helpfully exposes the sharks circling the NHS and the hypocrisy of those who applaud key workers one day and condemn them the next. However, we must also recognize that in important respects the NHS is not working in the best interests of public health. In some cases this may be due to massive underfunding and with political will can be easily corrected, while others require more fundamental change.
For example, driven by increased life expectancy, there is an epidemic of chronic disease and multimorbidity (when someone has two or more long-term health conditions). This is recognized as a defining challenge for health systems. This takes two forms. First, prevention: most chronic diseases are preventable. Yet only 5% of UK healthcare spending goes to prevention. Second, treatment: patients with multimorbidity now account for more than half of all GP consultations and hospitalizations and more than three quarters of prescriptions. Yet the NHS remains dominated by acute medicine and a single-disease approach, with specialists jealously guarding their turf.
As a result, patients (mostly older people) face multiple consultations (except in Scotland) and complex drug regimens. None focused on the ways in which conditions and drugs interacted. Furthermore, none address the underlying inequalities in multimorbidity: prevalence is higher and age of onset is lower among those living in disadvantaged areas.
Right-wing critics of the NHS ignore these questions; their interest is only in promoting markets and profits. Our response must be more complex: protect the NHS but change it from a reactive disease service to one focused on prevention and rehabilitation. Prof Alan Walker, Co-Director, Institute for Healthy Lifespan, University of Sheffield
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