It IS now almost 52 years since the National Health Service was first established on July 5, 1948, and at the start of the new millennium, the whole system is in danger of falling apart.

The initial concept of a free health service for everyone was a brilliant and brave objective, but since the scheme started, the level of demand for treatment has always exceeded the resources available. People are living longer than they did 50 years ago because of improved diet and advances in medical technology, and conditions such as tuberculosis that previously killed, can now be cured.

Because the NHS is being asked to work on totally inadequate financial resources, the increase in demand for treatment has resulted in longer and longer waiting lists. The Government has also found it necessary to impose restrictions on doctors prescribing some of the more expensive drugs on grounds of cost.

There have also been worrying reports in the press of elderly patients being denied treatment on grounds of age, and other reported cases of intravenous drip feeds being withdrawn. Those lucky enough to have private medical insurance receive the best available treatment, but for the rest of the population, the NHS is something of a lottery, with different treatment, or the lack of it, depending where you live.

Compared to our European partners, the UK has a chronic shortage of specialist medical staff. Many more specialists need to be trained as a matter of urgency before services can be improved, and this will take time even after the necessary funds have been allocated.

Over the years since the NHS was established, the governments of the day have tinkered at the edges of the NHS to produce short-term fixes for particular problems, but this has normally only been achieved by robbing Peter to pay Paul. Improving service standards in one medical speciality has usually resulted in deterioration of service standards in another department. All politicians are particularly adept at presenting smoke and mirror tricks to give the illusion that things are improving, but that is all it is - an illusion.

For the NHS to deliver a serious sustainable improvement in the quality of health care in this country, it needs a very substantial increase in the level of funding - perhaps as much as 50%. Is the public prepared to accept a large increase in the level for national insurance contributions to fund this improvement, and will any political party have the courage to adopt such a proposal as a platform in a future election campaign? Sadly, I think the answer is no on both counts.

So what is the alternative? As a first priority, a working party should be established to carry out a full review of the NHS and to bring about much better co-operation between the public and private sectors. At the moment they seem to work in competition with each other, but huge benefits could result from closer co-operation.

Problem with cost of cover
Private hospitals have excellent facilities, but they are forced to make high charges because their services are underused. Most private hospitals are being run on occupancy levels of around 50%. If occupancy levels could be increased across the board, then the hotel aspect of the charges could be reduced. Better use would be made of their excellent operating theatres and expensive diagnostic equipment and the cost of private medical insurance treatment would come down.

The private medical insurance companies are facing their own difficulties. With rising claims levels, premiums have been increasing in double digit figures, way ahead of the underlying inflation rate.

While new members are still joining private schemes to avoid the prospect of a long wait for treatment of the NHS, other policyholders on fixed incomes are being forced out of the market as the cost of cover moves out of their reach. Pensioners, in particular, are being squeezed back into the public sector just at the very time when they are more likely to need treatment, putting a further burden on the NHS.

The latest Government initiative is to allocate more funds to improve the service for cancer and cardiac patients.

The figures being talked about are peanuts against the actual level required, but what would be the effect if sufficient resources were made available to deliver and sustain a highly efficient quality of service in these two areas? The public would no longer demand fully comprehensive policies and insurance companies would be able to market new contracts at substantially lower premiums, excluding cancer and cardiac medical conditions from cover. This would result in many more individuals and employers entering the private sector for the first time as insurance costs fall to an affordable level. Currently, 11% of the population have private cover and this could rise to 25% or more.

Employer-based schemes
All possible obstructions should be removed to encourage the establishment of employer-based schemes. This means that the current "benefit in kind" tax charge on employees for medical insurance premiums paid by their employers, should be abolished along with the employers "benefit in kind" national insurance surcharge, due to come into effect in April 2000. These charges actively discourage employees and employers from making private provision and work against the national interest.

The overall result of the above scenario is that with many more people holding private medical cover for all other acute conditions, pressure on the NHS to deliver these services will be reduced. That, in turn, would reduce waiting lists and release financial resources to fund the extra investment in cancer and cardiac treatment.

This could be a "win-win" situation for all parties involved, but will the NHS or any political party be prepared to take up the challenge?