FUNDING THE NHS - IS THE NHS SUSTAINABLE

The survival of the NHS lies largely in the hands of government, and t his article suggests steps that it should take to deal with pressures on the NHS in terms of funding, managing efficiency, and demands. Chan ges to the system of funding may be unfeasible, but management could b e improved by research to allow greater understanding of the local eff ects of national policies. Alternatively health authorities could be g iven more freedom to manage funds, although this would have to be acco mpanied by stiff sanctions for those who failed. Demand could be conta ined by strengthening policies to ensure that new technologies are cos t effective. The government could try to reduce demands arising from i ncreased expectations by encouraging informed public debate about prio rities and influencing the availability of private health care. All th ese efforts should be guided by the values underpinning the NHS, which should be debated and decided collectively and confirmed in a new cha rter for NHS's 50th anniversary in 1998.