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Last Updated: Friday, 2 June 2006, 16:29 GMT 17:29 UK
Correspondent's view
Spiralling debts and job cuts are plaguing the NHS in England, bringing a new focus to how it operates in the 21st century.

Health workers in a variety of sectors offer their views on what is wrong with the National Health Service and prescribe their own remedies.

Here is the view of Mark Easton, BBC home editor.

DIAGNOSIS

Mark Easton

The NHS is an organisation in flux.

It has more money than ever before, more doctors, and more nurses.

New treatments and technologies arrive almost daily.

But for any of that to make a real difference requires a change in culture.

The government says it is determined to put the patient at the heart of decision-making which demands new ways of working, thinking and managing.

The extra billions are about much more than bed-pans and brain surgeons.

It's about power - does the patient trek across town to see the consultant or the other way around?

It's also about choice - which hospital, surgeon or GP would you like?

And it's about waiting - are we really heading for an NHS where waiting lists and waiting times are effectively abolished?

Recreating a market for healthcare with patient as consumer is raising historic ideological debates about the role of the private sector and the use of capitalist levers to manage a nationalised health service.

Only by resolving these tensions can the health service move to the next level.

PROGNOSIS

Chronic disease is likely to prove a huge challenge for our health service and our national life.

Diabetes, arthritis, depression, obesity, addiction - all are increasing and will have a debilitating effect on larger parts of the population.

What were once acute illnesses, such as some cancers, heart disease and Aids, are now also chronic ailments and the impact of an ageing population is going to place even greater pressures on health and social services.

The emphasis is going to shift from acute care to the long-term management of disease and disability. It may lead to a focus on preventative care - public health initiatives to help people live healthier lives.

The current national health service has been described as more of a national sickness service and it seems probable that as the costs and implications of living longer and the demands of the chronically sick become clear, the calls for an insurance-based system will grow louder.



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