IF you believed this week's spin, the NHS is being cured. The Government has achieved its target of ensuring that no one has to wait more than 15 months for in-patient treatment. This news was brought forward in order to persuade us that, since higher spending is working, we should swallow the bitter pill of tax rises to pay for even more of it.

In fact, reducing the number of patients with extremely long waits has been achieved at the expense of making more patients wait for shorter periods. Money has been poured into the NHS: the health budget in England has increased by more than a third in just four years. But the system has failed to respond. Almost no extra patients have been treated and more than a million people remain on waiting lists.

Nottingham City Hospital has done as the Government asked. Forty-seven patients had waited for more than 15 months in March 2001, but none had waited this long by March of this year. But over the same period, the overall number of waiting list patients in this hospital had risen from 4,481 to 5,516. No one waits like this in France or Germany, but here we are told that preventing people from waiting longer than a year and three months is a turning point. Such political targets distort clinical priorities and obscure evidence of real problems.

If Britain met the best European performance on cancer care, we would save 25,000 lives a year. But cancer services have deteriorated. Last year, fewer than a third of patients were given radiotherapy within four weeks of being told they needed it, compared with 68 per cent two years ago. A & E services tell the same story, with the number of patients waiting more than four hours to see a doctor increasing.

Less than a fifth of extra resources reach frontline services. New money is sliced into high-profile announcements or diverted to ensure that the latest political targets are met. Most of it has been spent on higher salaries rather than new staff. And huge sums are wasted. The Department of Health has admitted that up to a fifth of the NHS budget - £10 billion a year - is lost through waste, fraud and inefficiency. The NHS spends £1 billion alone on treating patients for infections they pick up in hospitals.

Britain is the only country in the developed world that relies on the taxpayer alone to fund its health services. With a mix of insurance and taxpayer funding, other countries are able to spend far more. France and Germany have twice as many doctors per head of the population as Britain. But simply raising spending on the NHS to reach European levels will not result in matching their performance. Northern Ireland and Wales already spend the EU average, but have longer waiting lists than England.

Other countries have more efficient systems that are more responsive to patients because governments do not spend the money. Premiums are paid to third-party insurers, which are under an obligation to serve customers. They compete and they offer far greater choice. And there is much more diversity of provision. Only half of Germany's hospitals are run by the state.

A woman needing a hysterectomy in Germany can go directly to a specialist for diagnosis and an operation, with the whole process usually taking only a few weeks. In the NHS, it may be weeks before she gets the appointment. Often she sees a junior doctor, who, rather than making a final decision, orders tests and further appointments. These are never on the same day. Patients may spend months coming back for tests, locked in a bureaucratic nightmare, before finally joining the waiting list proper. NHS inflexibility produces a cycle of inefficiency.

Diverse healthcare providers would encourage staff in innovative ways. In the 1970s, when family planning was a neglected service, the Government persuaded doctors to devote more effort to it by introducing payments for each procedure carried out. Such incentives worked then and could still be used.

It is regrettable that, instead of learning from the virtues of other health systems, the Government should now be attacking them, scaring people into believing that a taxpayer-funded NHS is the only fair option. Gordon Brown has suggested that a different system would mean patients without insurance facing bills of hundreds of thousands of pounds for medical treatment.

But social insurance schemes on the Continent ensure that everyone receives cover, including the disadvantaged. In fact, the poor in Germany or France receive better care than in Britain. We pay obeisance to the values of Beveridge and Bevan, while operating a two-tier health system. Only one in 10 people can afford the benefit of private healthcare. The rest simply wait.

With 1.5 million employees, the NHS has become an unmanageable empire. Conceived in an era of postwar rationing, this nationalised monopoly no longer offers the quality and choice of healthcare that patients deserve. We live in an age of consumerism and rising expectations. The most ambitious target in the Government's "10-year Plan" for the NHS is that no one should wait longer than four months for hospital treatment. But why should anyone in the world's fourth largest economy wait at all? The NHS institutionalises low expectations. In Holland, it is almost unthinkable for a consultant not to be present for a complicated Caesarean birth: the target for consultant presence in the NHS is one in 10.

I work in the NHS and believe in its ideals. But further spending increases alone will not be enough to solve its fundamental problems. It is time we debated a new way to finance and deliver healthcare. A more diverse scheme could provide higher standards of care and more choice to all patients, irrespective of their means. And it could remove healthcare from the control of politicians, returning power to the patients, to whom it properly belongs.

Jim Thornton. Reprinted from The Daily Telegraph 12 April 2002

·  The author is a professor at the University of Nottingham and an NHS consultant in obstetrics and gynaecology at Nottingham City Hospital

IF you believed this week's spin, the NHS is being cured. The Government has achieved its target of ensuring that no one has to wait more than 15 months for in-patient treatment. This news was brought forward in order to persuade us that, since higher spending is working, we should swallow the bitter pill of tax rises to pay for even more of it.

In fact, reducing the number of patients with extremely long waits has been achieved at the expense of making more patients wait for shorter periods. Money has been poured into the NHS: the health budget in England has increased by more than a third in just four years. But the system has failed to respond. Almost no extra patients have been treated and more than a million people remain on waiting lists.

Nottingham City Hospital has done as the Government asked. Forty-seven patients had waited for more than 15 months in March 2001, but none had waited this long by March of this year. But over the same period, the overall number of waiting list patients in this hospital had risen from 4,481 to 5,516. No one waits like this in France or Germany, but here we are told that preventing people from waiting longer than a year and three months is a turning point. Such political targets distort clinical priorities and obscure evidence of real problems.

If Britain met the best European performance on cancer care, we would save 25,000 lives a year. But cancer services have deteriorated. Last year, fewer than a third of patients were given radiotherapy within four weeks of being told they needed it, compared with 68 per cent two years ago. A & E services tell the same story, with the number of patients waiting more than four hours to see a doctor increasing.

Less than a fifth of extra resources reach frontline services. New money is sliced into high-profile announcements or diverted to ensure that the latest political targets are met. Most of it has been spent on higher salaries rather than new staff. And huge sums are wasted. The Department of Health has admitted that up to a fifth of the NHS budget - £10 billion a year - is lost through waste, fraud and inefficiency. The NHS spends £1 billion alone on treating patients for infections they pick up in hospitals.

Britain is the only country in the developed world that relies on the taxpayer alone to fund its health services. With a mix of insurance and taxpayer funding, other countries are able to spend far more. France and Germany have twice as many doctors per head of the population as Britain. But simply raising spending on the NHS to reach European levels will not result in matching their performance. Northern Ireland and Wales already spend the EU average, but have longer waiting lists than England.

Other countries have more efficient systems that are more responsive to patients because governments do not spend the money. Premiums are paid to third-party insurers, which are under an obligation to serve customers. They compete and they offer far greater choice. And there is much more diversity of provision. Only half of Germany's hospitals are run by the state.

A woman needing a hysterectomy in Germany can go directly to a specialist for diagnosis and an operation, with the whole process usually taking only a few weeks. In the NHS, it may be weeks before she gets the appointment. Often she sees a junior doctor, who, rather than making a final decision, orders tests and further appointments. These are never on the same day. Patients may spend months coming back for tests, locked in a bureaucratic nightmare, before finally joining the waiting list proper. NHS inflexibility produces a cycle of inefficiency.

Diverse healthcare providers would encourage staff in innovative ways. In the 1970s, when family planning was a neglected service, the Government persuaded doctors to devote more effort to it by introducing payments for each procedure carried out. Such incentives worked then and could still be used.

It is regrettable that, instead of learning from the virtues of other health systems, the Government should now be attacking them, scaring people into believing that a taxpayer-funded NHS is the only fair option. Gordon Brown has suggested that a different system would mean patients without insurance facing bills of hundreds of thousands of pounds for medical treatment.

But social insurance schemes on the Continent ensure that everyone receives cover, including the disadvantaged. In fact, the poor in Germany or France receive better care than in Britain. We pay obeisance to the values of Beveridge and Bevan, while operating a two-tier health system. Only one in 10 people can afford the benefit of private healthcare. The rest simply wait.

With 1.5 million employees, the NHS has become an unmanageable empire. Conceived in an era of postwar rationing, this nationalised monopoly no longer offers the quality and choice of healthcare that patients deserve. We live in an age of consumerism and rising expectations. The most ambitious target in the Government's "10-year Plan" for the NHS is that no one should wait longer than four months for hospital treatment. But why should anyone in the world's fourth largest economy wait at all? The NHS institutionalises low expectations. In Holland, it is almost unthinkable for a consultant not to be present for a complicated Caesarean birth: the target for consultant presence in the NHS is one in 10.

I work in the NHS and believe in its ideals. But further spending increases alone will not be enough to solve its fundamental problems. It is time we debated a new way to finance and deliver healthcare. A more diverse scheme could provide higher standards of care and more choice to all patients, irrespective of their means. And it could remove healthcare from the control of politicians, returning power to the patients, to whom it properly belongs.

Jim Thornton. Reprinted from The Daily Telegraph 12 April 2002

·  The author is a professor at the University of Nottingham and an NHS consultant in obstetrics and gynaecology at Nottingham City Hospital