Same shortcomings of NHS have existed for years

EDITOR—Smith et al's editorial comments on the current problems of the NHS.1 They mention several shortcomings that I and many colleagues have wearied of highlighting to governments: decades of massive underinvestment and serious shortages of acute and intensive care beds and of general practitioners, consultants, nurses, and other healthcare professionals.

In a debate on the NHS in the House of Lords in November 2001 many excellent speeches followed my opening remarks, but, as is usual in such debates in the Lords, the views were ignored by the media (including the BMJ). I made several recommendations to the government that I regarded as crucially important in the present, sad state of the NHS—sad despite the dedication and skill, often deployed under intolerable conditions, of most healthcare professionals. I had six principal recommendations:

• Increase acute and intensive care beds urgently and reopen closed community hospitals, which accept patients after early discharge from acute services, thus reducing bed blocking

• Expedite increases in general practitioners, consultants, and nurses (who will require increased remuneration to attract them to the service)

• Expand rapidly all public-private collaboration so as to use to better advantage spare capacity in the private sector

• Restore and extend tax relief on private medical insurance, withdrawn because of outdated ideological concepts

• Implement rapidly the Savill report of the Academy of Medical Sciences and the Follett report and reduce sharply the clinical pressures on academics to correct the parlous state of clinical academic medicine

• Lastly, as I recommended to the Merrison Royal Commission on the NHS more than 30 years ago, consider urgently introducing an index linked, income related health tax, probably as a supplement to national insurance. I shall again be told, of course, that the Treasury won't stand for hypothecated taxation; will any government have the courage to confront that body in order to introduce such a much needed reform?