Field's radicalism won't work

Frank Field is simply wrong when he says that the NHS cannot deliver a first-class health service to poor and rich alike under the current system of funding ("Don't ignore the core, Tony", 16 August).

Why? Because NHS funding comes from general taxation, widely regarded by all health economists as the fairest way for people to pay for healthcare, according to their means, not their level of sickness. NHS resources are allocated to local health authorities in England by a formula that takes account of mortality and morbidity, so that those who need healthcare the most get a larger slice of the cake. This redistributes resources in a way that directly benefits poorer areas of the country.

With a strong basis in primary care, readily accessible to all, the NHS presents remarkably few barriers to those in need. Field's proposals would make the NHS less responsive to the needs of the poor.

A system based on local taxation would require the poorest areas with the sickest people to contribute the most. Rich communities would not be required to redistribute their resources to poorer communities. The scope for additional fund-raising from affluent communities would further enhance inequalities (as so often is the case with schools in middle-class areas).

Public subscription favours high-tech, hospital-focused care, not the care of chronically sick and disabled people who suffer a disproportionate amount of morbidity, who often live in poorer communities and who consume a vastly greater amount of overall NHS resources.

The NHS is a success story in terms of providing treatment and care based on individual need, not on the ability to pay. It is a unifying factor in British society, unique as a public-sector organisation in being used on a daily basis by citizens from all walks of life.

However, let us not be complacent. There are things that need to be addressed and some of these do need a radical approach, but not the radicalism Field proposes. To transfer the NHS to local political control is the last thing we need and would be a damaging distraction.

Stephen Thornton
Chief executive, NHS Confederation
London SW1

This article first appeared in the 13 September 1999 issue of the New Statesman, Kids just say no to party politics