It was good to see Martin Wolf’s piece on the need for greater public participation in public policymaking (“British citizens should be asked to do more”, Opinion, July 22).
This was a key recommendation emerging from the BMJ’s Commission on the Future of the NHS, relating to NHS funding, which we published this year.
Apart from (re)building trust in politics and politicians — as Wolf notes — greater public participation could also build consensus concerning the opportunity costs implicit in NHS spending choices.
There are strong arguments for a short-term boost to NHS spending. But longer term, funding decisions will become increasingly difficult. If UK NHS funding were to grow at its historic average rate, by 2058 its share of gross domestic product would double to nearly 17 per cent. And, by the end of the century, it would consume more than a third of the UK’s wealth.
Mathematically — and, importantly, economically — at some point the NHS funding growth curve has to better align with broader economic growth.
We believe that greater public engagement in understanding and confronting the trade-offs in long-term NHS funding choices would better connect them with the political policy process.
Professor John Appleby
Senior Associate, The Nuffield Trust
Commissioner, BMJ Commission on the Future of the NHS
