From the Editor Journal of the Royal Society of Medicine; 2018, Vol. 111(6) 187 DOI: 10.1177/0141076818782032 Kamran Abbasi Editor, JRSM The questions about the NHS’s sustainability are authors, it is best achieved by a cross party commis- centred on its ﬁnancial viability. While there are sion on health and care. many dimensions to this debate, a taxation-based The future success of the NHS will also be deter- system remains under scrutiny. Twenty years ago, a mined by innovation and focusing on value. Mahtani senior economist at the World Bank told me that our et al. believe that the time is right to introduce para- tax-based model was unsustainable. Most health sys- medics in general practice. This month’s research tems were funded by insurance schemes, and it was a paper ﬁnds that the cost of ‘low value’ prescribing matter of when, not if, the NHS would follow suit. is rising and is subject to regional variation. We This year, a German policy maker explained to me also need robust research, and some of the world’s that Germany-maintained funding increases in its best in methodology demonstrate the importance of health system during the ﬁnancial crisis because the allocation concealment and the steps required to min- funding model was diverse; in other words not solely imise it in the design, conduct and reporting of trials. reliant on taxation. Enter Mahiben Maruthappu and Dominic References Marshall to help analyse the various funding options 1. Maruthappu M and Marshall DC. Viable funding for the NHS. Their argument is that there are three options for the National Health Service in England. possible futures for the NHS. First, in the absence of J R Soc Med 2018; 111: 189–194. 2. Mahtani KR, Eaton G, Catterall M and Ridley A. new money, productivity must be stepped up. Setting the scene for paramedics in general practice: Alternatively, public funding might be released for what can we expect? J R Soc Med 2018; 111: 195–198. the NHS by reallocation of funds from other sectors, 3. Walker AJ, Curtis HJ, Bacon S, Croker R and Goldacre by raising national insurance or introducing a B. Trends and variation in prescribing of low-priority hypothecated tax. The third model is privatised med- treatments identified by NHS England: a cross-sectional ical insurance. study and interactive data tool in English primary care. More funding will only arise from political action, J R Soc Med 2018; 111: 203–213. and while this crisis might seem unprecedented, the 4. Schulz KF, Chalmers I, Altman DG, Grimes DA, authors remind us that sharp political intervention Moher D and Hayes RJ. ‘Allocation concealment’: the was also required in 1951, 1968, 1976, 1987–1988 evolution and adoption of a methodological term. JR and 1999. Whatever the way forward, say the Soc Med 2018; 111: 216–224.
Journal of the Royal Society of Medicine – SAGE
Published: Jun 1, 2018
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