Page last updated at 16:05 GMT, Wednesday, 2 July 2008 17:05 UK

Does the NHS have a future?

By Mark Easton
Home editor, BBC News

Surgery
Continued universal free access to care is in doubt
The simplicity of the National Health Service idea has survived the complexity of extraordinary medical progress.

Universal, funded from taxation and free at the point of need - these are phrases which Health Secretaries have reiterated for six decades, the principles which underpin the NHS.

The British public loves its health service, but can it survive another 60 years?

Can a system of free medical care for all be maintained in the face of new and expensive treatments, and with a population becoming ever more knowledgeable and more demanding?

Some doctors argue that the traditional NHS is doomed because the state cannot afford to fund an ever increasing array of drugs and procedures.

The future has to be about a tax-based system that is a core package that is reasonable and everybody accesses it - but if you want to have some luxury items, you top-up
Professor Karol Sikora
Cancer Partners UK

Physicians like cancer specialist Dr Karol Sikora argue that the result will be a two tier service.

He said: "The future has to be about a tax-based system that is a core package that is reasonable and everybody accesses it - but if you want to have some luxury items, you top-up."

It is a vision that has sent shudders through government.

Alan Johnson, the Health Secretary for England, attempted to outlaw such top-ups by ruling that any patient who bought additional care or drugs privately would be denied NHS treatment for their condition.

The papers were filled with stories of patients who had spent their life-savings on drugs the health service refused to provide and who were then advised that their NHS treatment was being withdrawn.

In a statement to Parliament, Mr Johnson said: "A founding principle of the NHS . . . is that someone is either a private patient or an NHS patient."

It proved a desperate attempt to hold back the tide and last week he dropped the policy in favour of a formal consultation on the matter.

However, it is an issue that will have to be faced.

Drug company pressure

Drugs companies like Roche UK are knocking on the doors of the advisory bodies which regulate the availability of drugs on the NHS, calling on them to give their products the green light.

It's really a moral decision, whether as a society we decide we want to stay in all this together or we want start going our own ways
Niall Dickson
King's Fund

"There will be changes in the overall drugs budget within the NHS," said Julian Cole from Roche.

"Money can be released from elsewhere within the health service to actually fund many of these drugs.

"They are cost-effective, providing good value for money and so if there is a will to provide that funding then it will follow."

But if the NHS did agree to fund any drug for which there was demand, how much more would it cost?

As Medical Director of the private healthcare company Cancer Partners UK, Dr Sikora has calculated that if the NHS agreed to fund ten cancer drugs currently unavailable it would push the bill up by almost 0.9 billion.

The government believes it is a lot less, but no-one denies that protecting the principles of the NHS will mean spending significantly more.

Public will

The independent health think tank The King's Fund, though, argues that recent history demonstrates that voters will pay more to protect the health service.

Niall Dickson, the chief executive, is confident that a tax funded universal system can be afforded.

FIND OUT MORE
NHS graphic
As the NHS turns 60, BBC News is giving it a health check. Watch out for reports, features and analysis on TV, radio and the web.

"It's really a moral decision, whether as a society we decide we want to stay in all this together or we want start going our own ways," Dickson believes.

"There is no sign yet that the British people want to go their own way."

As the great and the good gathered this afternoon at Westminster Abbey to celebrate sixty years of the NHS, it is clear the service stands at a crossroads.

We face a choice: a health service that limits its ambition to providing good enough care.

Or a genuinely universal system that costs a lot more but is true to its principles.

The path we choose will depend on how much we think that simple original idea is worth.




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