Health insurance and the future of the NHS

Sir, Melanie Phillips is right that the only solution to the NHS’s problems is a continental-style insurance scheme (Opinion, Apr 12).

This has been indicated ever since 2005 in our annual Euro Health Consumer Index, which compares and ranks European national healthcare systems. Continental “Bismarck” health insurance systems outperform the British, Italian, Spanish and Nordic “Beveridge” systems. This is particularly true for accessibility — ie, the absence of waiting lists — where even oil-rich Norway has problems.

The continental systems have much less micro-management from on high, and rely more on responsibility and accountability being shown by the medical profession. Particularly in the Netherlands, this is boosted by a legal obligation for the profession to liaise with patient organisations. In other words: let the professionals run the show, and make sure they talk to their customers frequently.

The NHS’s problem is most likely not a lack of resources: it is inherently cheaper to run a healthcare system without waiting lists than to have them. Waiting lists create extra work, draining the healthcare organisation of resources. I know this from having been CEO of the University Hospital of Northern Sweden, where I was hired to cut costs. After three years of cutbacks, involving reducing the number of staff by 1,000, we ended up operating the first waiting list-free large hospital in the country since at least 1945.

Professor Dr Arne Björnberg

Chairman, Health Consumer Powerhouse

Sir, The track record of private contractors for NHS and social care services is mixed, to stay the least, and Melanie Phillips does not name one example where they have outperformed incumbents. Nor is it inevitable that the only way forward is mixed insurance models. The NHS, as a dominant-payer model, keeps costs down and ranks highly in several international studies on equity of access, efficiency and value for money. It is more poorly funded, staffed and bedded than most systems in the OECD. Rather than talking it down, we could instead choose to fund and staff it properly.

Professor David Oliver

Sulhamstead, Berks

Sir, Melanie Phillips omits to mention that our northern European neighbours spend far more than we do on healthcare: on a comparable basis, France 20 per cent more per capita, Germany 30 per cent more, Holland 50 per cent more, etc. She also seems to think that European healthcare is uniformly better than ours. It isn’t. Studies comparing nations’ healthcare show that some European countries perform better than we do and some worse.

Nobody is suggesting that the NHS does not have significant problems that need fixing, but an insurance-based system is not the answer.

Gil Patrick

Fenton Pits, Cornwall

Sir, I have been privileged to be a consultant in the NHS for 27 years: it delivered my children; it cares for my elderly parents; it replaces my friends’ hips and knees and provides them with state-of-the-art pacemakers; it treats their cancers and manages their chronic illnesses. According to the Nuffield Trust, which ought to know these things, the NHS is stable or improving in 25 out of 27 international indicators, and it does this with a financial efficiency that shames many countries with much larger health budgets.

The NHS is far from perfect. It is bureaucratic, cumbersome, underfunded and has no control over the ever-increasing demand on its services. Working in the NHS can be Kafka-esque and frustrating, and many of us could tear our rapidly greying hair out on a regular basis. But it does miracles every day, and we need to remember and celebrate this.

Dr David Bogod

West Bridgford, Notts

STEEL RESCUE PLAN

Sir, The announcement that the British government is prepared to co-invest with a private-sector buyer of Tata Steel is the first meaningful step it has made in trying to catch up with events and help to save the bulk of British steel-making (report, Apr 12).

A state-supported financial “lifeboat” was always feasible and was well short of nationalisation. Simply injecting state funds into a company did not mean it was nationalised. This was the case with Rolls-Royce in the 1970s and UK banks recently.

At last the government has escaped from its ideological straitjacket and given a positive statement of intent. However, if the investment is not to throw good money after bad there must be a package of measures.

The uncomfortable truth is that neither difficult demand and supply conditions, nor the impact of the Chinese, prevented the German and Dutch steel industries in 2015 increasing output by 2 per cent and 8 per cent respectively. The damage to UK steel is self-inflicted by business rates six to eight times those experienced by competitors, and by eye-watering energy costs. If this cost problem is not addressed then nothing will have changed.

Emeritus Professor Garel Rhys

Cardiff University

MUSLIM INTEGRATION

Sir, Trevor Phillips worries about the lack of Muslim integration (“Two thirds of Muslims would not give police terror tip-offs”, Apr 11). Does he think that Sikhs and Hindus are more in tune with British culture? If so, he could not be more wrong. Lack of cultural integration afflicts not just Muslims but Sikhs and Hindus too. Some Sikh temples in the UK, for example, have recently placed a ban on solemnising interfaith marriages, although no such religious ban exists in Sikhism. Moreover, Britain’s Hindus, despite having lived here for years, campaigned vigorously in the last election against the inclusion of caste discrimination in Britain’s equality laws, although such law already exists in India.

The ultimate criterion of integration is the extent to which immigrants identify with Britain as a country, believe in its creed and espouse its culture, and correspondingly reject loyalty to other countries as well as their values and cultures. We have so far seen little evidence of that criterion being met in Britain.

Randhir Singh Bains

Gants Hill, Essex

POPE AND MARRIAGE

Sir, Cristina Odone (Thunderer, Apr 12) believes that if the Pope had got out more he might have allowed divorcees to access the Eucharist through a blanket new rule. Yet Francis has long been familiar with marriage breakdown and the modern family realities — incuding among many of his own relatives.

The Pope opted for a case-by-case discernment rather than a general relaxation of the rules because of Jesus’s clear teaching on marriage indissolubility (“What God has bound . . .”) Any general readmission to the Eucharist of the remarried without annulment would — as the two-year Bishops’ Synod concluded — renounce the Church’s commitment to that teaching.

However, God’s mercy is also clear teaching; hence the Pope wants to ease ways for the Church to determine if God really has bound a marriage. It is not ignorance that drives his exhortation, The Joy of Love, but a bold attempt to balance God’s two-fold invitation: on the one hand to lifelong covenantal love, on the other the possibility of a fresh start when that fails.

Austen Ivereigh

Author, The Great Reformer: Francis and the Making of a Radical Pope

MEDICS: ROWING, RUGBY OR READING?

Sir, Further to the letters on applying to medical school (Apr 11 & 12), in the early 1960s, for most people, A levels were pass or fail. There were about 12 medical schools in London, each wanting students with different aptitudes. At my first interview at St Mary’s, my interviewer’s face dropped when I said I enjoyed rowing, not rugby, and I was politely shown the door. My next interview was at Charing Cross: a beam came over the face of the professor of bacteriology, Harry Winner, when I told him that I had just read one of Christopher Isherwood’s novels.

Two days later the good news came through the letterbox.

Dr Michael Waugh

Leeds

AVOID DAYTIME REST

Sir, Dr Mark Porter warns us off going to bed when feeling ill (Times 2, Apr 12) based on a review of evidence from a team at Swansea University. The physician Richard Asher told us this nearly 70 years ago in a paper entitled The Dangers of Going to Bed published in the BMJ (1947) and subsequently reproduced in a collection of Asher’s incomparable wisdom: Talking Sense (1972). In our medically anxious society, doctors and patients could gain much from Asher’s commonsense views.

Jonathan Hooker

Chichester, W Sussex

HERITAGE PRICE HIKE

Sir, Far from hiding our reduced rate for our senior members, as has been suggested (“National Trust hikes prices for pensioners”, Apr 13), we actively promote it in a number of ways; the significant number of people taking up the offer suggests that the message is getting through.

Many members are aware of the reduced rate but because they appreciate that we are a charity they choose to continue paying the full price. A large number of members do not provide details of their date of birth, so we do not know from our database everyone who is eligible.

As we do not receive any direct government funding, we rely on the support of our members and supporters to fund our conservation work, the costs of which rose by 15 per cent last year.

Sue Wilkinson

Director of supporter development, National Trust

DITCH THE ITCH

Sir, I can sympathise with Carol Midgley (“I’m itching to ditch my nylon tormentors”, Apr 8), except that my tormentors are thick woollen tights — even hotter worn inside the house, but essential to wear outside in the British spring. I can’t wait to abandon them, but know it won’t be until the temperature reaches a healthy 15C. So spare a thought for another sufferer, Carol.

Pat Andrew

Nottingham

SPORTING MINNOWS

Sir, Further to your excellent leader (“Sporting Chance”, Apr 12) on the three-point shot in basketball, I was head of PE in a school in Bethnal Green when three boys, who had never played basketball before, entered the school. There were no tall players in the school team, so these three trained hard to develop the three-point shot. This proved so successful that the school won several schools’ national championships. This skill led to their selection for the England Schools’ basketball team. In 1986, at 15 years of age, they helped their club side, the East London Royals, to win the national under 19 cup final at the Albert Hall. All three were offered scholarships in the United States, but only one took it up.

Humphrey Long

England youth basketball coach 1970-87, Romford, Essex

CORRECTIONS AND CLARIFICATIONS

The article “When it comes to nuclear’s future, it’s time to think small” (Business Comment, April 11) stated that Hinkley Point C “promises to provide power for 50 million homes”. The correct figure is about 5 million homes.

In our article (“Labour welcomes back blogger who compares Israelis to Nazis”, News, April 2), we had no intention to accuse Tony Greenstein of being antisemitic. As Mr Greenstein has told us, he is Jewish and is an anti-Zionist. We are happy to put this on record.

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