IN May 2000 I wrote a letter to The Herald asking "when therefore will our politicians come clean and admit that our unique NHS is now time-expired?"

Clearly this diagnosis was premature, but prophetic, and my suggested remedy prescient. This was to adopt a European model where tax-funded health care was supplemented by a mix of social and top-up private insurance, but still providing universal health care.

Competition drives up standards, bureaucracy is kept to a minimum, and health service staff are independent of government control. Unless, however, the public are prepared to accept Scandinavian levels of taxation, there is clearly no prospect of the NHS and social care receiving the necessary funding in the years to come. Most politicians have known this for some time, but have demeaned their profession by pretending otherwise. Many doctors have realised this recently, but for reasons about which I can only conjecture, have chosen not to comment on possible solutions other than ever more money from the Treasury.

Today's suggestion that the "wealthy" might pay some of the costs of their health care ("Using the NHS will stay free, insists Sturgeon", The Herald, November 22) suggests an ill-thought-out panic response, when a considered transition to the much more effective European model should be the response.The International Health Care Outcomes Index 2022 reveals that despite average funding levels, UK health care outcomes are near the bottom of a league table of 18 comparator countries; the NHS is an institution crying out for reform. However, with the intellectually limited and politically inept SNP in charge in Scotland, any transformation of health care could be problematic.

Public opposition to the use of private money in the NHS has long been vocal but illogical, with PPI procurement contributing, and spending on private health services increased throughout this century. However, I remember performing operations in Glasgow's private hospitals at weekends when "waiting list initiatives" introduced by New Labour permitted patients on NHS waiting lists to have their procedures carried out sooner in the private sector, and I only recall one patient declining.

The consultant contract of 2003, a Faustian pact, replaced an open-ended contract with a time-sensitive one defined by job plans. The GP contract removed the requirement to provide out of hours services, and the fragmentation of a unified NHS began. It is time now to accept that the 1948 design is indeed time-expired, a two-tier system now exists, and to adopt a European model with better health care outcomes.
John Sinclair, retired consultant surgeon, Milngavie

Take charge of our own health

MOST developed countries already have a two-tier system based on free care for all topped up by private insurance – and better health care, Germany being a prime example.

But they are not imprisoned in a free, all you can eat NHS guarded by a herd of sacred cows whose cost, in real terms, has almost trebled in real terms from £74bn in 2019 to £193bn today.

On the assumption that Humza Yousaf doesn't intend landing some people with the whole bill for their treatment, why doesn't he put out a challenge to our world-beating insurance industry to come up with a Scottish Government-underwritten scheme that could also be sold across the UK?

In terms of reducing demand these schemes normally come with regular, mandatory health checks in order to reduce their, and the patient's, risk of illness. In fact, why not make that mandatory for all NHS patients?

Scotland has the highest rate of preventable deaths in the UK – 40% higher, in fact – mostly due to obesity, drugs, smoking and alcohol.

If everyone had a five-minute session with a practice nurse who did a basic check on blood pressure, blood sugar, weight and other vital signs and issued advice, surely enough people would have the common sense to take action that would improve and save their lives, reduce the cost of the NHS and improve the service.

I don't actually know why I bother writing, because it's clear no politician, in Scotland or the UK, is willing to take the flak and endanger his party's electoral chances by advocating what is, after, people taking responsibility for their own lives.
Allan Sutherland, Stonehaven

Time to introduce benefits in kind

THERE are obviously many problems with the NHS which I have no ideas about. However, the idea that we might get the better-off to pay more for the service is one that I agree with. This could be done through taxation by making the NHS, prescriptions and care at home benefits in kind. Building this into the tax system it would mean those who could afford it would be partly paying for their benefits but keeping the principle of free at the point of service and yet those with the broadest shoulders will pay a bit more.

I know that when I was working the private health cover I had was charged quite steeply as a benefit in kind. The option of opting out would need to be addressed but could be handled.
Jim McAdam, Maidens

No reason for the disparity

WHEN faced with a dilemma it’s always a good policy to stand back and look at things in the round rather than focusing on the current aspect of the problem. The NHS is in crisis and the consensus is that it is understaffed and underfunded; conversely the private health sector is blossoming. The bottom line is that there is no reason why this disparity should exist. It hasn’t happened by accident, it has been a deliberate choice foisted on us by successive Westminster administrations. Holyrood may allocate the budget but Westminster decides how much it is.

Why do we have an NHS, because it’s actually only a few decades old? The answer is simply that after two successive world wars the Establishment realised that in order to placate a populace that was at the end of its tether major societal changes were required, hence free healthcare was one of the changes introduced. A dispassionate analysis of subsequent events from the Thatcher era onwards shows a gradual withdrawal of all the post-war sops that were given to the general public to keep them docile and compliant. Talk of a “two-tier” NHS is just another step in conditioning the great unwashed to accept the eventual dismantling of the NHS which will be accelerated by the period of recession and austerity the UK now faces.

The distribution of wealth in the UK and the grip that gives the Establishment over the so-called democratic processes at Westminster will ensure that while the Chancellor of the Exchequer reduces the tax burden on the banking system, the NHS withers and dies.
David J Crawford, Glasgow

Where is the leadership?

IT is appalling that a group of senior executives consider it legitimate to attack the very essence of our health service. The future of our health service is for the people of Scotland to decide, represented by their Government.

The term leadership bears no meaning associated by a group of highly-paid technocrats failing in managing our health services.

I have recently retired after a long period of time as a chief executive, latterly in NSW Australia. The service in Australia is in many aspects remarkable. However, paying for visits to the GP, paying for prescriptions and requiring insurance for diagnostics and elective surgery drives inequalities. If you claim the title leader then stand up and be held to account, not sit in an unelected huddle dreaming up ideas that strike at the heart of our NHS. This unwelcome and largely ludicrous intervention needs to be addressed.

The position of the chief executive of the NHS in Scotland is untenable.
Gerry Marr, Glasgow

Celebrate a great service

CATRIONA C Clark (Letters, November 22) makes the valid point that before prescription charges were abolished by the SNP Government many people had to choose which medication was the most necessary; now that is no longer the case, to the benefit of their health.

I appreciate that not everyone will have had my positive experience, but over recent weeks I've twice contacted my GP surgery on a Monday and been given appointments two days later. Thank you to Park Avenue surgery in Stirling. Last week I had to attend the Cardiology Unit at Forth Valley hospital for a "procedure" and again everything went exactly to time with no signs of stress from the excellent professionals who attended to me. I don't dispute that there are challenges all across the NHS but I think it is also important to celebrate the wonderful service that is provided, free at the point of need.
Ruth Marr, Stirling

Read more letters: Is it really so abhorrent to be charging for NHS services?


Letters should not exceed 500 words. We reserve the right to edit submissions.