The profits of such a privatization would then be siphoned off by the agency and lead to inflated bonuses for those at the top and dividend payments to shareholders. A further result is that those working in the service are often seen as goods and chattels, to be sold to the highest bidder, and the ethos of the grounded public service is eroded. In addition, we will see services fragment as companies seek to acquire those in areas where profitability will be assured. This, we must conclude, will not include areas of the country where deprivation is higher. Health inequalities will increase further. I’m not sure what Nye Bevan would now call those who seek to destroy the NHS that he and others passionately advocated in the 1940s. Using the term “parasites” to describe the Tories may be somewhat outdated and perhaps one that reflects their present nature might be more appropriate, such as ‘hyena’ or ‘vulture’. Dr Peter WimpennyBig Sand, Highland Polly Toynbee helpfully exposes the sharks prowling the NHS and the hypocrisy of those who applaud key workers one day and condemn them the next. However, we must also recognize that, in important respects, the NHS does not operate in the interests of public health. In some cases this can be attributed to massive underfunding and, with political will, could be easily fixed, while others require more fundamental changes. For example, due to increased longevity, there is an epidemic of chronic disease and multimorbidity (where someone has two or more long-term health conditions). This has been identified as a defining challenge for health systems. This takes two forms. First, prevention: most chronic diseases are preventable. However, just 5% of UK health spending goes to prevention. Second, treatment: patients with multimorbidity now account for over half of all hospital visits and admissions, and over three quarters of prescriptions. However, the NHS is still dominated by acute medicine and a single disease approach, in which specialists jealously guard their turf. As a result, patients (mainly elderly) face multiple visits (except in Scotland) and complex drug regimens. No one focuses on the ways in which conditions and drugs interact. Moreover, none address the large disparities in multimorbidity: prevalence is higher and age of onset lower among those living in deprived areas. Right-wing critics of the NHS ignore these issues. Their interest is only in promoting purchases and profits. Our response will have to be more complex: to defend the NHS, but to change it from a reactive disease service to one that focuses on prevention and recovery. Professor Alan Walker Co-Director, Healthy Lifespan Institute, University of Sheffield Have an opinion on anything you’ve read in the Guardian today? Please email us your letter and it will be considered for publication.
