Abstract
The questions about the NHS’s sustainability are centred on its financial viability. While there are many dimensions to this debate, a taxation-based system remains under scrutiny. Twenty years ago, a senior economist at the World Bank told me that our tax-based model was unsustainable. Most health systems were funded by insurance schemes, and it was a matter of when, not if, the NHS would follow suit. This year, a German policy maker explained to me that Germany-maintained funding increases in its health system during the financial crisis because the funding model was diverse; in other words not solely reliant on taxation.
Enter Mahiben Maruthappu and Dominic Marshall to help analyse the various funding options for the NHS. 1 Their argument is that there are three possible futures for the NHS. First, in the absence of new money, productivity must be stepped up. Alternatively, public funding might be released for the NHS by reallocation of funds from other sectors, by raising national insurance or introducing a hypothecated tax. The third model is privatised medical insurance.
More funding will only arise from political action, and while this crisis might seem unprecedented, the authors remind us that sharp political intervention was also required in 1951, 1968, 1976, 1987–1988 and 1999. Whatever the way forward, say the authors, it is best achieved by a cross party commission on health and care.
The future success of the NHS will also be determined by innovation and focusing on value. Mahtani et al. believe that the time is right to introduce paramedics in general practice. 2 This month’s research paper finds that the cost of ‘low value’ prescribing is rising and is subject to regional variation. 3 We also need robust research, and some of the world’s best in methodology demonstrate the importance of allocation concealment and the steps required to minimise it in the design, conduct and reporting of trials. 4