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The best 70th birthday presents we could give to the NHS | Letters


It was no surprise to read that the very first lesson you suggest could be learned from overseas (Five things the NHS could do to improve service, 3 July) is the establishment of integrated health and social care, as has happened in New Zealand. The achievements of the Attlee government are at the heart of my socialist beliefs but the compromises which led then to the split between free NHS care and means-tested social care remain the achilles heel as the NHS celebrates 70 years. It is utterly ludicrous to have separate systems which imply distinct and neat boundaries between health and care, with rather a lot of people making a good living arguing on which side of the fence some poor demented soul belongs. Disputes around the funding of continuing care have become a major industry.

The recent NHS funding announcement, making no reference whatsoever to social care, evidenced the fact that the government still hasn’t the least idea of how the two are umbilically linked. From as far back as 1998 to as recently as last month, the health select committee has argued for properly joined-up provision. The Treasury opposes a formal integration but continuing separation is costing billions in terms of delayed discharges and other inefficiencies.
David Hinchliffe
Former chair, Commons health committee, Holmfirth, West Yorkshire

Sonia Sodha argues (Opinion, 4 July) that to safeguard the future of the NHS we should join up NHS and social care budgets and extend the NHS’s free-to-all principle to social care . She is right. The barrier between the budgets for health and social care is unhelpful and the Barker commission on the future of health and social care recommended a single, ring-fenced budget covering both, with spending gradually rising as a proportion of GDP to bring us into line with countries such as France and Germany. This increase, while significant, is affordable if we are prepared to make hard choices about taxation and spending.

Barker also backed a version of free personal care in England for those with the highest levels of need. The cost of implementing the policy would be high, but only slightly more expensive than the “cap and floor” social care reform proposed by the Tories at the last general election. But the prize is significant – an end to much of the complexity, barriers to integration with the NHS and inequity that plagues the current system.
Professor Chris Ham
Chief executive, The King’s Fund

The new genetics laboratory redesignation process in the NHS is gearing up to deliver new ways of delivering DNA testing, particularly for those with newly diagnosed tumours. Identifying the underlying genetic abnormalities in a tumour can allow oncologists to “tailor” treatments to the genetic problem. This may mean patients get a more appropriate and sometimes less toxic treatment rather than receiving “standard” therapy for that particular tumour type. While only a proportion of patients who have genome analysis performed on their tumour will have a change of treatment, those treatments are likely to be more effective – and potentially more cost effective – for the NHS.

This new way of assessing tumours from their DNA will mean that the NHS in England will lead the world in undertaking this through a publicly funded service. Up until now, testing of tumours has been for a handful of genetic changes or one or two genes and this has often not been universal. In Manchester, we have been able to develop testing of tumours for the breast and ovarian cancer genes, BRCA1 and BRCA2. This can identify genetic changes that are not inherited, in turn allowing patients to have extremely effective new treatments, called Parp inhibitors.

The new NHS service that tests all genes will give a much more comprehensive analysis while still identifying those genes that are currently tested. This development should be strongly supported and lauded as a major step forward for the NHS on its 70th birthday.
Dr Gareth Evans
Professor of clinical genetics, Manchester

Why does the NHS have “the lowest per capita number of doctors, nurses and hospital beds in the western world” (The NHS at 70, 2 July)? Because, starting in 1991 resources have gradually been channelled out of clinical care and into the NHS market, the trappings of privatisation.

In 2011, the Commons health committee on NHS commissioning reported that the cost of the purchaser-provider split had increased management and administration costs from 5-6% to around 14% of total NHS expenditure. This split was described as a “costly failure”, yet it persists to this day. Hospitals have been converted into businesses called trusts with chief executives and non-executive directors. Private health companies with their lawyers and accountants excel at winning contracts, but not at delivering the service. They are adept at suing the NHS for supposed faults in the tendering process.

There has been extensive use of external management consultancies to buttress the market philosophy and its implementation. In the two years since the authority was set up, the so-called NHS Improvement has paid KPMG £630,000 to help define its culture, values and operating model and McKinsey £500,000 to clarify its purpose and model.
Morris Bernadt
London

Polly Toynbee refers to the disastrous 2012 Health and Social Care Act (Opinion, 3 July), which created the bureaucracy of the clinical commissioning groups and the consequent fragmentation of the English NHS. I was astounded to recently discover that my local CCG is currently recruiting “lay members” to work 3.5 days per month and be paid a salary for which the full time equivalent rate would be in the region of £77,000 per annum. Money which, if CCGs were abolished and England followed Scotland’s sensible policy of having regional health authorities, could be much better spent on patient care.
Ian Arnott
Peterborough

Amyas Morse (NHS funding boost not enough, 2 July) says he wants “a service that tries to prevent illness”. Since the NHS was founded there have been volumes of scientific research into the developmental and social origins of disease, yet hardly any of it has been translated into national policy. We now know that the human foetus is exquisitely sensitive to its environment. Poor diet and chronic anxiety in pregnancy have a lasting effect on the neurology, physiology and psychology of the growing child. There are similar outcomes from maternal depression after the baby is born. Though the mother’s condition may improve, the baby’s body systems have been altered.

Whether social or personal in origin, perinatal stress in mothers leads to higher levels of illness in their offspring, such as obesity, diabetes, depression, heart and lung disease. All of these put huge pressures on health services. Real prevention means aiming for equal chances for every child to be. Only a national health service can provide integrated multidisciplinary care for all pregnant women and their families.
Dr Sebastian Kraemer
London 

When I started my clinical training at Guy’s hospital in 1958 and the NHS was just 10 years old, I was solemnly assured by my teachers that it was “crumbling”, “on its last legs”, and was unlikely to survive for another five years. Fortunately this has turned out to be too gloomy a prognosis. But as for the future…
Peter Wemyss-Gorman
Lindfield, West Sussex

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