Polly Toynbee illuminates as well as conservatives and the right-wing press are seeking to undermine the National Health Service (NHS wrecks cannot accept that the British public still supports it, 27 June). We have seen it happen with all our utilities where funding is reduced below the required level and privatization is then seen as a savior, with investments and a type of business management that focuses on reducing wages and increasing profits. This approach began with the adoption of the Griffiths report in the 1980s and a reduction in clinical leadership.
Then, the profits from this privatization will be removed from the service and will be used to inflate bonuses for the highest and pay dividends to shareholders. Another result is that those who work in the service are often seen as goods and movable property, which are sold to the highest bidder, and the grounded ethos of the public service is reduced.
In addition, we will see that services are fragmented as companies seek to take over those in areas where profitability will be assured. That, it must be concluded, will not include the areas of the country where deprivation is highest. Health inequalities will increase even more.
I’m not sure what Nye Bevan would now call those seeking to destroy the NHS that he and others passionately championed in the 1940s. Its use of the term “descent” to describe conservatives may be a bit outdated, and perhaps one that reflects its current nature may be more appropriate, such as “hyena” or “vulture.” Dr. Peter WimpennyBig Sand, Highland
Polly Toynbee usefully exposes the sharks surrounding 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 does not work in the best interest of public health. In some cases, this can be attributed to large underfunding and, with political will, could be easily resolved, while in others they require more fundamental change.
For example, driven by increased longevity, there is an epidemic of chronic disease and multimorbidity (where someone has two or more long-term health conditions). This has been recognized as a definite challenge for health systems. This takes two forms. First, prevention: Most chronic conditions can be prevented. However, barely 5% of UK healthcare spending goes to prevention. Second, treatment: Patients with multimorbidity now account for more than half of all GP consultations and hospital admissions, and more than three-quarters of prescriptions. However, the NHS remains dominated by acute medicine and a single-disease approach in which specialists jealously protect your lawn.
As a result, patients (mostly the elderly) face multiple consultations (except in Scotland) and complex drug regimens. No one focuses on the ways in which conditions and drugs interact. In addition, no one addresses the large inequalities in multimorbidity: the prevalence is higher and the age of onset is lower among those living in disadvantaged areas.
NHS right-wing critics ignore these issues; its only interest is to promote markets and profits. Our response should be more sophisticated: advocating for the NHS, but shifting it from a reactive disease service to one focused on prevention and rehabilitation.Prof Alan WalkerCo-Director, Healthy Lifespan Institute, University of Sheffield
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