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Letter of the week: Patient-held budgets are privatisation by the back door

Dr Simon Fradd's opinion piece on patient-held budgets highlights the true agenda of the NHS reforms: the end of ‘free at the point of use' (Be brave, and hand the purse strings to patients).

Everyone has different healthcare needs: some will need tens of thousands of pounds' worth of care, others very little. How does one allocate patient-held budgets? Nobody has been able to explain what happens when your personal budget runs out yet.

Will it be like in the US when insurance companies stop paying out, regardless of what treatment you still require?

Dr Fradd simply says patients will ‘clamour' for more money. Why should patients have to do that to get the care they need? That would be a fundamental departure from the principles of the NHS.

And let's talk about ‘top-ups' and co-payments too. This is a way of allowing the more wealthy to pay for better care.

It is something the health insurance industry has been pushing for many years. It will also be a departure from the fundamental principle of the NHS, which is that people receive the care they need regardless of their ability to pay.

This ‘patient choice' rhetoric is flimsy cover for naked privatisation. Dr Fradd's article demonstrates that those of us who fought the Health and Social Care Bill were quite right to warn about the damage to the NHS. He reported ‘a terrible amount of opposition' to commissioning – in my opinion there was not nearly enough.

From Dr Mary-Louise Irvine, Lewisham, south-east London - Member of BMA Council