Stuart Rodger: The big questions facing our health service

Published on Monday 22 June 2009 10:04

LESS than a year after the NHS celebrated its 60th anniversary, it finds itself under increasing financial pressure, and new questions are being asked about how much longer we can continue to afford the NHS.

Why is this happening? That is something the Royal College of Physicians of Edinburgh will examine at a conference in Edinburgh today.

New and expensive drug treatments are offering increasingly sophisticated, targeted, treatment for a number of diseases, but local NHS prescribing budgets are limited and uncomfortable decisions are having to be made about which drugs the NHS can afford to prescribe to patients.

Patient demand for drug treatments which may improve the quality of life, but which have not been approved at a national level on grounds of cost, has led to much discussion about "co-payment". This is the question of whether those who can afford and choose to access some additional treatments not available on the NHS privately should also be entitled to receive other aspects of care free on the NHS.

While guidance has recently been produced to enable some form of co-payment in Scotland and England, many believe this will lead to a two-tier system of healthcare, based upon an individual's ability to pay.

The role of the voluntary sector in supporting the NHS has previously been under-recognised. As the recession continues, there is further pressure on NHS budgets, medical research and, ultimately, patient care.

What effect will these factors have on the NHS and its ability to provide free care for patients?

Can the NHS continue to deliver the quality of care which doctors believe is essential and which patients expect? How much longer can we realistically expect to afford the NHS? Is it now time the UK considered adopting a different form of healthcare system?

While we may not be able to answer all of these questions today, there is an increasing need to start a national dialogue.

Dr Stuart Rodger, is lead organiser for the RCPE charity.