Introducing 'An International Voice' and how to have your say.

Donald Light, Professor of comparative health care systems, based at the University of Pennsylvania in USA.

British studies consistently show a high level of support and satisfaction with the NHS, but a comparative survey done at Harvard University found that more Brits than any other nation apart from Americans said that fundamental change was needed in their system. Is it worth spending more to change the problems of the NHS, or should that money go to education, employment or housing?

Future challenges arising from past decisions include:

• GPs dropping sicker patients from their lists and referring on problems to cut costs.

• GPs are protected by an independent contract. Yet experience shows that two thirds of primary care work can be done by less expensive nurses. Which GP functions do make economic sense?

• Are managers and ministers ready to step on some big toes to move away from uneconomical traditional district general hospitals?

Fears that over the next generation health and welfare costs will rise due to an ageing population are not founded. From an international perspective, British costs are the lowest in Northern Europe and the ratio of working age people to elderly people will decline less than in any other country except Norway.

Rising expectations and demand suggest that the NHS needs a new social contract with its customers. What should be its terms?

A prominent American group of research and policy leaders have concluded that 70 per cent of diseases and disorders can be prevented or postponed, saving billions in acute services. But in the NHS, successful prevention is just an added cost, so how can that vision be realised?

User participation and a new commitment to patient involvement and openness is needed. For a democratic country, the NHS is surprisingly hierarchical and autocratic.

The Nuffield Trust recently demonstrated that NHS staff have higher sickness rates than the general public. How will the NHS recruit and train a growing workforce when the conditions and pay are becoming less attractive?

Even an optomistic realistic has good reasons to believe the gap between services and funding will widen. Should the NHS therefore narrow its services to emergency and acute interventions? Should health care go private? Should there be a supplementary health care tax or a voluntary contributory scheme? I think there is a case for all three - give us your views at the conference.

Please take the time to fill in a questionnaire on this strand of the Debate for Our Future.

You can also register your overall personal view of what you think the NHS needs to do to ensure it thrives.

Read the full text before joining the debate.

What do your colleagues think? Come to Earls Court July 1-3 and find out. Join the interactive 50th celebrations!

Please contact us if you have any queries or would like further information: future.issues.nhs@dial.pipex.com