Polly Toynbee illuminates so well how the Tories and the rightwing press seek to undermine the National Health Service (The NHS wreckers cannot accept that the British public still back it, 27 June). We have seen it happen to all our other public services where funding is reduced below the level required and privatisation is then seen as a saviour, with investment and the sort of business management that is focused on reducing wages and increasing profits. This approach started with the adoption of the Griffiths report in the 1980s and a reduction in clinical leadership.
The profits of such privatisation will then be sucked out of the service and go towards inflating bonuses for those at the top and paying dividends to shareholders. A further outcome is that those who work in the service are often seen as goods and chattels, to be sold to the highest bidder, and the grounded public service ethos is diminished.
In addition, we will see services becoming fragmented as companies seek to take over those in areas where profitability will be assured. That, it must be concluded, will not include areas of the country where deprivation is highest. Health inequalities will increase further.
I am not sure what Nye Bevan would now call those who seek to destroy the NHS that he and others passionately argued for in the 1940s. His use of the term “vermin” to describe Tories may be somewhat outdated, and perhaps one that reflects their present nature may be more appropriate, such as “hyena” or “vulture”.
Dr Peter Wimpenny
Big Sand, Highland
• Polly Toynbee helpfully exposes the sharks circling the NHS and the hypocrisy of those who applaud key workers one day and condemn them the next. However, we must also recognise that, in important respects, the NHS is not working in the best interests of public health. In some cases this can be put down to huge underfunding and, with political will, could be remedied easily, while others require more fundamental change.
For example, driven by increased longevity, there is an epidemic of chronic conditions and multimorbidity (where someone has two or more long-term health conditions). This has been recognised as a defining challenge for health systems. This takes two forms. First, prevention: most chronic conditions are preventable. Yet barely 5% of UK health spending goes on prevention. Second, treatment: patients with multimorbidity now account for over half of all GP consultations and hospital admissions, and more than three-quarters of prescriptions. Yet the NHS remains dominated by acute medicine and a single-disease approach in which specialists jealously protect their turf.
As a result, patients (mostly older people) are faced with multiple consultations (except in Scotland) and complex drug regimes. No one is focusing on the ways in which the conditions and the drugs interact. Moreover, no one is addressing the major inequalities in multimorbidity: the prevalence is higher and the age of onset lower among those living in deprived areas.
The rightwing NHS critics ignore these issues; their interest is only in promoting markets and profits. Our response should be more sophisticated: defend the NHS, but change it from a reactive sickness service to one focused on prevention and rehabilitation.
Prof Alan Walker
Co-director, Healthy Lifespan Institute, University of Sheffield
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