The subject of changes to the NHS has been a hot topic among readers this week. Here's an edited selection of your comments
This week Comment is free debated the NHS plans being proposed by the government. George Monbiot argued that David Cameron was trying to enable more privatisation of the NHS, while Jon Healey explained why Nick Clegg would not be able to stop the plans. Hundreds of you discussed these issues over the course of the week; this is what you told us:
GoldenHorn
Working in the service I have a fairly good knowledge on such matters. The NHS [is not] bad, but … people are living longer. In the past, a lot of medicine was based on the young and on acute care, but with the ageing population things cannot stay the same as they need a different kind of care. That is one of the many reasons we cannot afford to stand still if we want to maintain our high health outcomes.
daffers56
I work in the NHS; most of my friends work in the NHS and support for the changes is not palpable where I work. People who I communicate with in other parts of the country are also pessimistic. My guess is that the majority of employees and public are sceptical at best. Most reasonable people appreciate change is an evolving process and has to happen, but the Tory proposals are a dangerous precedent and hopefully will meet with great resistance.
Johnd44
Once the damage is done it will be impossible to put things back the way they were. By the time that Labour get back into power it will be far too late to do anything except try to improve on whatever mess we have then. It will be impossible to turn the clock back because, by then, our health service will be fragmented into a complex mosaic of separate entities and in the hands of scores, if not hundreds, of foreign companies whose only criteria will be their profit margins.
Highbury
Once a public service is put out to tender or "commissioned", private companies can mount a legal challenge to force that contract to become open to the private sector. Now that the NHS has been forced by Labour to "commission" there is no way that it can stop outsourcing to the private sector. It was Labour that chose to introduce "commissioning" but the Lisbon treaty then enforces that such commissioning should be extended to the private sector. Much as I hate this bill, it has to be said that Labour opened the stable door and the horse is already away and over the hills.
andygibb
I still cannot believe that people are banging on about the necessity to modernise the NHS and privatise it. This programme seeks to model one of the most efficient and cost-effective health services in the world – the NHS – on one of the least: the US system. OECD figures show that healthcare in the US costs $7,500 per person per year. The OECD average is $4,500. In the UK it costs $3,500. Yet while the US system is plagued with fraud and lawyers, while it overtreats the rich and dumps the poor in the street, the NHS came out top of the countries surveyed in the journal Health Affairs on most measures of public confidence and public access. (The US came bottom.) As Major did with the railways, Cameron wants to take a functioning system and smash it into chaotic fragments.
NotAnApparatchik
What I and David Cameron want is a National Health Service that is fit for this century and serves the people rather than unions and I don't care how it's structured as long as it works.
And before the left wing complains about my comments, I'm someone who has a very real stake in this country's healthcare in this country as I've had a serious illness twice in under two years.
thebigredone1
We are in a situation that, as Vernon Bogdanor has pointed out, is constitutionally unique. Put simply, there is no mandate for this top-down reorganisation of the NHS and the progression of New Labour marketisation of the health service to its neoliberal conclusion. We are in a unique situation in which a pillar of the post-war settlement is being dismantled without popular support or constitutional justification.
redshrink
As a medical student in Germany in the 1980s, the NHS was presented to us as the most efficient health service in the world, albeit grossly underfunded. Britain at the time was spending less than half on health than Germany. The NHS's strength was its emphasis on public health and the integration of care. Many other countries have been struggling to achieve this. Integration of care in psychiatry in Germany, for example, is poor compared with the UK.
The introduction of the profit incentive has increasingly been distorting practice. Companies operating for profit have one overarching aim, namely to increase profit. The "reforms" of the health system, which are nothing but the complete commercialisation of healthcare, will see UK health expenditure rise very sharply over the next decade.
For all the successes of the NHS, health outcome differential across social classes remains enormous. This is a reflection of how unequal society is in the UK. The dismantling of public health service provision will certainly make this worse.
WoollyMindedLiberal
The French have the very best healthcare system in the world and much of it is provided by the private sector. They not only spend more efficiently but also spend more than us. Most European countries do.
If you look across the channel you'll see that our NHS is not an achievement. It looks rather like a clapped-out and failing 1945 Austin with a hand-crank while the Germans have the latest hybrid BMW 7-series and the French are enjoying a state of the art Renault.
nickmavros
Says Dave: "It's because I love the NHS so much that I want to change it." Perhaps you could try hating it a little bit? Go on, just a bit. Spoil yourself!
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