Letter

Keep it public

Dear healthmatters - Hospital prices are rising rapidly. Health authorities can afford fewer services, and trusts are becoming more reliant for their income on charity and private work. Trust status for community units is threatening the whole system of district nurses and community midwives, and undermining the health promotion role of school nurses, health visitors, child welfare clinics and family planning clinics. A whole range of services supporting sick or disabled people is being cut back at a time when the need for community care has never been greater. The 1990 act is beginning to work as intended.

Must we now accept all this? Must we accept that the NHS is no longer to be regarded as a universal and comprehensive service, but a basic and probably (as is now being discussed in some first-wave community trusts) a means-tested service?

The NHS Support Federation continues to strongly oppose the components of the reforms which have dismantled the principle of equity - ie trusts and GP funholders. But our autumn campaign is aimed at introducing one simple safeguard for NHS patients.

In 1986 the guidelines which set a 10% limit on private practice in the NHS hospitals were quietly withdrawn. In 1990 the NHS and Community Care Act granted trusts the freedom to introduce whatever charges they wished and to choose whether to make contracts with the NHS or not. These clauses in the legislation are beginning to eat away at free provision from the inside out, aided and abetted by desperate underfunding and a forthcoming public spending round which will not help NHS purchasers buy sufficient services for their populations.

Meanwhile, the sharks lurking in these troubled waters - the private insurers - are looking to trusts for cheaper prices than private hospitals in order to keep their premiums down.

The NHS Fed will be campaigning to bring back the ten percent limit. We will be campaigning for a minimum of 90% of NHS beds and services to be retained for NHS patients, together with the unfashionable but vital cry for spending on the NHS to increase in line with the scale of its task.