US and British health specialists support the NHS

The British National Health Service has long been admired around the world for providing health care for all citizens, in a manner that regards each life as equally precious. Your system of universal healthcare allows citizens to access medical care when needed, free of charge, funded by taxes paid by all. It is based on improving the health and wellness of all. The health security enabled by your system is but a dream for many Americans.

As American health care professionals who often use the example of the NHS to advocate for a fairer and better system in the US, we have recognised recent developments in England that are deserving of concern. In particular, we express concern over movements toward transferring more and more services to for-profit corporations in your healthcare system and measures that encourage the development of a self-pay market for care. Access to treatment should not depend on whether someone can spare the money. While some may say the changes in England have so far only been at the margins, it is the risk of a slippery slope that should cause concern.

In the US over recent decades, we have lived the challenges of a multi-tiered, for-profit healthcare system. Wealthier citizens can afford the best care. At the same time, in the same society, other citizens struggle to pay for care, sometimes choosing between food or medicine. Many rely on the emergency room for routine care. Many suffer the consequences of doing without healthcare. It is harder to maintain support for a public system when the wealthy rely on paying for better access to care.

There are many things the US healthcare system has to admire, such as our pioneering integrated care organisations and our world-leading medical research and high-tech rescue care. At the same time, the US is in the midst of a major healthcare reform effort that aims to bring affordability and equity to American healthcare. We caution the UK against moving in the direction of a system that has created the inequality in US that we are now working to repair. Your universal, public healthcare system is an example to the world, and something of which Britain should be proud. We urge you to preserve it.
Dora Wang MD Physician
Arthur Lavin MD Pediatrician and faculty
Donald Nguyen Pediatric urologist
Lisa Marlowe PsyD Clinical psychologist
Cyndi Fowler Nurse executive
Ryan Q Simon MD Consultant physician
Scott Tyson Physician
Rebecca Jones MD Physician
Katherine Lambes MD Internal medicine/pediatrics
Lisa Vantrease MD Family physician
Christopher M Hughes MD Physician
Richard Bruno MD Resident physician, family & preventive medicine
Richard Waters MD Primary care physician
Katherine Scheirman MD MHA US Air Force colonel (retired)
Scott Nass MD MPA family physician
David Sanders MD Physician
Elizabeth Wiley MD JD MPH resident physician
Michael Kaplan MD Family physician and associate medical director
Andrea DeSantis DO Family physician
Margaret Flowers MD Co-director
Garrett Adams MD MPH past president, Physicians for a National Health Program
Don R McCanne MD Senior health policy fellow
Morris Brown MD National Medical Association Chairman, Family Medicine
Natalie Spicyn MD MHS primary care physician
Xaviour Walker MD DTM&H hospitalist and general preventive medicine resident
Mark Ryan MD FAAFP Assistant professor, department of family medicine and population health
Danielle Alexander MD Physician
Cecile Rose MD MPH Professor of medicine
Kyle Bohan MPH DO Physician
James P Scott MD Past president, National Physicians Alliance
Christopher Brown MD MPH Chief resident, internal medicine
William B Jordan MD MPH Physician
Li-hsia Wang MD FAAP General pediatrician
Kristin Huntoon Resident physician
Alap Shah MD Professor of Family Medicine
Stephen Marsh MD Family medicine resident
Kevin Burns MD Family physician
Henry L Abrons MD MPH Pulmonary and critical care, retired
Shelly Choo MD MPH Resident physician
Irmina Sultana Haq MD MPH Resident physician
Walter Tsou MD MPH Past president, American Public Health Association
Gene Bishop Clinical asociate professor
Max Romano Johns Hopkins University School of Medicine
Tim Lachman MD Associate professor of clinical neurology
Adam Law MBBS MSc MD FRCP Attending physician in endocrinology
Carla Campbell MD MS Associate teaching professor
Esther K Chung MD Professor of pediatrics
F. Stuart Leeds MS MD Assistant professor of family medicine
Gary L LeRoy MD Family physician
James Plumb MD MPH Professor of family and community medicine

• As senior public health professionals, we must draw attention to the damage that the coalition government’s policies have done to the health of the British people. First, it placed “responsibility deals” with producers of junk food and alcohol at the centre of its public-health strategy. As its own evaluation confirms, these have achieved almost nothing. Second, it has delayed action on issues such as reducing the salt hidden in food, which researchers have linked to 6,000 additional deaths.

Third, it has failed to implement minimum unit pricing for alcohol, again in the face of research evidence that this would save thousands of lives. Fourth, its austerity policies can be linked to a reversal in the long-term downward trend in suicides, which have increased most where welfare cuts have been most severe. These policies have also contributed directly to a marked increase in food poverty, with growing numbers dependent on food banks. Fifth, it has failed to address the already poor health of British children. The areas where the government has made progress, such as standardised packaging for cigarettes and antimicrobial resistance, show what could have been done.

This reluctance to act, whether due to ideology, closeness to corporate interests or fears of being accused of “nanny-state tactics”, has been damaging to health and has led to many thousands of unnecessary deaths. Whatever government is elected this week, we call upon it to put evidence before ideology. The people’s health must come first.
Professor Martin McKee CBE Professor of European Public Health, London
Professor Simon Capewell Professor of Clinical Epidemiology, Liverpool
Professor John Acres Professor of Public Health, Southampton
Professor Sheila Adam CBE Former Deputy Chief Medical Officer, England, London
Dr Sushma Acquilla Former Academic Registrar, Faculty of Public Health, Northallerton
Dr Tim Anstiss Founder: Academy for Health Coaching
Ms Pam Ashton Public health community advisor, Merseyside
Prof Sue Atkinson CBE PH Consultant & Former Regional DPH, London
Professor Gus Baker Professor of Clinical Neuropsychology, Liverpool
Professor Clare Bambra Professor of Public Health Geography, Durham
Dr Ben Barr Senior Clinical Lecturer in Applied Public Health Research, Liverpool
Professor Yoav Ben-Shlomo Professor of Clinical Epidemiology, Bristol
Professor Richard Bentall Professor of Clinical Psychology, Liverpool
Professor Susan Bewley Professor of Complex Obstetrics, London
Dr Chris Birt Honorary Research Fellow, Liverpool
Professor Carol Brayne Professor of Epidemiology, Cambridge
Professor Nicky Britten Professor of Applied Health Care Research, Exeter
Dr Catherine Brogan Public Health Chief Executive, London
Professor Eric Brunner Professor of Social and Biological Epidemiology, London
Dr Andrew Burnett Former Director Of Public Health, London
Professor Francesco Cappuccio Professor of Cardiovascular Medicine & Epidemiology, Warwick
Professor Martin Caraher Professor of Food and Health Policy, London
Professor Sir Iain Chalmers Co-founder Cochrane Collaboration Oxford
Dr Kailash Chand OBE General practitioner Tameside & Glossop
Dr Elaine Church Consultant Obstetrician and Gynaecologist
Professor Aileen Clarke Professor of Public Health& Health Services Research Warwick
Professor Jeff Collin Professor of Global Health Policy Edinburgh
Professor Anthony Costello Professor of Global Health, London
Dr Jack Czauderna Former GP, Sheffield
Professor Linda de Caestecker Honorary professor at the University of Glasgow, Glasgow
Professor Carol Dezateux CBE Professor of Paediatric Epidemiology, London
Professor Peter Diggle Distinguished University Professor of Epidemiology and Statistics, Lancaster
Gina Dowding County Councillor Lancashire
Professor Elizabeth Dowler Professor in Food & Social Policy, Warwick
Professor Christopher Dowrick Professor of Primary Medical Care, Liverpool
Dr Maria Duggan Director, London
Professor Shah Ebrahim Professor of Epidemiology, London
Dr Etheline Enoch Ebola Clinical Lead, London
Professor Matt Field Professor of Psychology, Liverpool
Professor John Gabbay Former Professor of Public Health, Southampton
Professor Mark Gabbay Professor of Primary Care, Liverpool
Professor Amandine Garde Head of Law Department, Liverpool
Dr Katy Gardner Senior Partner, London
Dr Clare Gerada MBE General Practitioner, London
Professor Ruth Gilbert Professor of Clinical Epidemiology, London
Professor Anna Gilmore Professor of Public Health, Bath
Professor Mark Gilthorpe Professor of Statistics, Leeds
Professor David Gunnell Professor of Epidemiology, Bristol
Professor Sir Andy Haines Professor of Public Health & Primary Care, London
Professor Gerard Hastings OBE Professor of Social Marketing, Stirling
Dr Fengjun He Senior Research Fellow, London
Professor Susan Higham Professor of Oral Biology, Liverpool
Dr Alison Hill Consultant in Public Health, Oxford
Dr Judith Hooper Retired Director of Public Health, Kirklees
Professor David Hunter Professor of Health Policy and Management, Durham
Professor Bobbie Jacobson OBE Former Director, London Health Observatory, London
Professor Ann Jacoby Professor of Medical Sociology Liverpool
Professor Philip James CBE Honorary Professor of Nutrition, London
Dr Tony Jewell Former Chief Medical Officer, Wales Cardiff
Professor Lynne Kennedy Head of Department of Clinical Sciences & Nutrition, Chester
Professor Kay-Tee Khaw CBE Professor of Clinical Gerontology, Cambridge
Professor Tim Lang Professor of Food Policy London
Professor David Lawrence Honorary Senior Lecturer in Health Services Research, London
Professor Andree Le May Co-editor, Journal of Research in Nursing, Southampton
Professor Alastair Leyland Professor of Statistics, Glasgow
Professor Stuart Logan Cerebra, Professor of Paediatric Epidemiology Exeter
Professor Graham MacGregor Professor of Cardiovascular Medicine London
Professor Rajan Madhok Retired NHS director of public health and medical director NHS Manchester
Professor Barrie Margetts Professor of Nutrition, Southampton
Professor Alan Maryon-Davis Former President, Faculty of Public Health, London
Dr David McCoy Reader in Public Health, London
Professor Stewart Mercer Professor of Primary Care Research, Glasgow
Professor John Middleton Independent Public Health Consultant, Coventry
Dr Clive Needle Policy & Advocacy Director, London
Professor Kate O’Donnell Professor of Primary Care Research & Development, Glasgow
Professor Eileen O’Keefe Emeritus Professor of Public Health, London
Dr Steven Oliver Senior Lecturer, York
Dr David Pencheon OBE Director, Norwich
Professor Kate Pickett Professor of Epidemiology, York
Professor Jennie Popay Professor of Sociology and Public Health, Lancaster
Dr Dan Pope Senior Lecturer in Public Health, Liverpool
Professor Geof Rayner Honorary Research Fellow, London
Dr John Robson Reader in Primary Care & Tower Hamlets/ GP, London
Professor Ted Schrecker Professor of Global Health Policy, Durham
Professor Alex Scott-Samuel Honorary Professor, Liverpool
Professor Alwyn Smith CBE Emeritus professor of epidemiology, Manchester
Professor David Stuckler Professor of Medical Sociology, Oxford
Dr Qutub Syed Former Regional Director of Public Health, Manchester
Dr David Taylor-Robinson Senior Lecturer in Public Health, Liverpool
Dr Arpana Verma Senior Lecturer & Honorary Consultant in Public Health, Manchester
Professor Ian Watt Professor of Primary Care, York
Dr Jane Wells Consultant in Public Health, Oxford
Professor Margaret Whitehead WH Duncan Chair of Public Health, Liverpool
Professor Ewan Wilkinson Professor of Global Public Health, Chester
Professor Graham Winyard CBE Former Deputy Chief Medical Officer, Winchester
Dr Katrina Wyatt Associate Professor of Health Research, Exeter
• The crisis in nursing is just one sign of malaise in the NHS. The loss of qualified nurses (community nurse numbers alone have been cut by over 3,300) means that the NHS relies on costly agency staff or overseas nurses (recruited at the cost of £5,000 each). Too few nurse training places have been commissioned because saving money trumps workforce planning. Putting things right requires more than extra funding: money is being wasted on privatisation.

The NHS is now a market in which private companies compete to provide services – especially since the Health and Social Care Act 2012, which itself cost £3bn to implement. This market may be costing the NHS more than £10bn a year; tendering for one contract can cost £1.5m of public money. Private providers have to put profits before patient care.

For nurses, the current NHS business ethos of wanting more for less exhausts us, stresses our managers, robs us of their support and leadership, encourages bullying, silences whistleblowers and holds down pay. The crisis in nursing requires an end to privatisation, possible with support for the NHS (Reinstatement) bill. There are 680,000 registered nurses: if parliamentary candidates want our vote, they should think carefully about how they treat our NHS.
Professor Helen Allan Professor of Nursing
Professor Fiona Ross CBE
Professor Jane Salvage Nursing consultant
Professor Di Marks-Moran Honorary professor, Nursing
Liz Meerabeau Professor of Healthcare, retired
Pam Smith Professorial fellow
Susan Osborne CBE Director of nursing and safe staffing
Gillian Black District nurse, former director of nursing
Dr Loretta Bellman Consultant, nursing and healthcare
Dr Jan Savage Nurse researcher
Lucy November Midwife and public health practitioner
Zeba Arif RCN Forensic Nursing Forum
Rebecca Newman Hospice nurse
Anita Weston Sexual health nurse
Val Thurtle Health visitor lecturer
Angela Tod Clinical nursing researcher
Irena Chojnacka Professional lead, adult nursing
Linda Burke Higher education
Jennifer Kempinski Palliative care nurse
Claire Honey Health visitor
Nina Heaps Health visitor
Gwen Vardigans RCN North Yorks Branch secretary
Paula Denham Clinical nurse specialist, palliative care
Aisling Donnelly Health visitor
Berit Moback Project manager, end of life care
Clare O’Riordan Profession development lead, health visiting and school nursing
Anna Edge Health visitor
Jennifer Walker Nurse practitioner, general practice
Mike Travis Children’s nurse, RCN council member
Andrea Jennings District nurse (community nursing)
Stella Backhouse Nurse blogger
Christina Sosseh Community learning disability nurse
Karen Taylor District nurse team leader, Queen’s nurse, community practice teacher
Gay Lee Palliative care nurse
Laurance Druiff Senior nurse, HIV and sexual heath
Caroline Smith District nurse
Gillian Meldrum Midwife
Abbey Eboigbe Sexual health nurse adviser/HIV nurse
Jill Highet Retired palliative care specialist nurse
Shazeda Begum District nursing, Community
Shirley Ali Anaesthetic nurse
Gill Todd RMN (psychiatry)
Karen Sanders Intensive care nursing/nurse education
Teresa Loy Private sector
Carlos Forni Locum community psychiatric nurse
Michael Martin Cardiothoracic nurse
Christina Clark Community psychiatric nurse
Nicky Parry Education/RGN/end of life care
Carey Johnson Haematology registered general nurse
Laura Clark Community psychiatric nurse
Alison Mansfield Ward sister, palliative care – hospice
Sharon Carter Diabetes specialist nurse
Trudi James Health visitor
Vicky Sorel-Cameron Palliative care
Veronica Killen Senior lecturer

• Professor Chris Ham and Nigel Edwards (Letters, 29 April) make important points about NHS funding. But the political parties are also largely missing the opportunity to talk about what they will do to improve patient safety in the NHS. This is a fundamental point and one that should not be ignored in the general election campaign. Tens of thousands of unregulated health professionals continue to perform investigations, tests and procedures on patients.

This is despite their work coming with considerable risks to patients. The consequence is that they are not subject to any kind of fitness to practice tests, nor the previous government’s “duty of candour”. It is difficult to identify errors or incompetent practitioners, and harder still to drum them out of the health service. The political parties have a responsibility to talk about how they will fund the NHS in the future. They also have a duty to explain how they will keep patients safe. And this must involve the statutory regulation of such professionals.

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