SOME TALK AT LAST ABOUT ENDING BRITAIN'S NHS

A tax-funded National Health Service, free at the point of use for all, is unsustainable and should be scrapped, Britain's most senior doctor says today. In an interview with The Daily Telegraph, Bernie Ribeiro, the new President of the Royal College of Surgeons, says health care in this country should be paid for instead through a social insurance system, similar to that used in France and Germany. Patients would pay a proportion of the cost of their treatment, and take out insurance to cover that cost. "If we are to provide health care free at the point of need all the time for patients, then I don't think that's achievable in the present structure," says Mr Ribeiro. "We will have to look hard at an alternative system." His comments will reignite the political debate about the funding of health care in Britain.

Although some senior figures in the Labour Party called for the introduction of a new funding mechanism in the last Parliament, Gordon Brown ruled out changing the way in which the NHS was paid for. He raised national insurance, following the publication of the Wanless report into the future of the NHS, to increase the resources available for health care.

The intervention from such a senior doctor will also put pressure on the Tory leadership contenders to take a more radical stand in order to differentiate themselves from Labour. Although shadow frontbenchers visited other European countries to explore alternative funding mechanisms before the last election, the party ruled out moving to a social insurance system because it feared a public backlash to such a reform. Andrew Lansley, the Tory health spokesman, said yesterday: "We just don't know what level or standard of care the NHS is capable of providing under the current system if the resources are used efficiently. There are many steps to go through before we get to that stage."

However, Mr Ribeiro criticises such political caution and calls on the Government to reconsider the introduction of a social insurance system in order to generate extra resources for health care and make people value the treatment they get. "We're not a poor country, the working population is reasonably well paid, we could afford our workers to make an identifiable contribution towards health care - not one hidden in national insurance and taxation. "I think the public would be prepared to pay, it's a question of how you structure it. We seriously need to look at this again." Under such a system, he says, contributions would be means-tested, with the poorest paying nothing at all. The rising cost of technology and medical staff will, he argues, make a tax-funded NHS completely unsustainable in the medium term. Mr Ribeiro says: "We're not talking about health care now, we're looking at health care in the future. Look at the cost of technology. "If we're going to have a health care system suited to the future, we've got to be prepared to invest in it. I don't personally believe that can be done out of pure taxation."

A social insurance system would also, he believes, create a stronger link between the money people spent and the treatment they received. "People value what they pay for. The NHS isn't free but people don't see a link between their money and the service." The Government needs to make some tough choices about what should be available on the NHS, he adds. "I would prefer to say we will give you the best emergency care possible, but you may not get all the elective work you want done on the state." Mr Ribeiro calls on the Government to create up to 1,000 more training posts for hospital consultants so that junior doctors who have finished the first stage of their training can go on to become specialists. Earlier this week, the British Medical Association said too many junior doctors were unable to find jobs.

Mr Ribeiro raises concerns, too, about the European working time directive, which imposes a 48-hour working week. The new regime will, he says, make it almost impossible for surgeons to complete their training satisfactorily. "Surgery is a craft, it takes time to learn it." He also criticises the imposition of waiting list targets, which he says have distorted clinical priorities and may even have contributed to the spread of MRSA. "The Government sets targets but, when I do a clinic I'm talking to an individual, not a disease or a statistic. The pressures on the health service from targets have made things go wrong."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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