Mal Fletcher considers the future of the NHS.

Mal Fletcher

The National Health Service is an institution of which Brits are rightly proud and which we all want to preserve and protect. Obviously, anything that can realistically be done to boost its chances of future success would be welcome.

Today, the Liberal Democrats are recommending an "extra penny in the pound" tax increase to support the cash-strapped NHS.

As a social futurist, I'm sometimes asked in sessions presented to civic leaders what shape the NHS might take in 10-20 years time. My honest response is that I can't see the NHS existing in its present form two decades from now - for one simple reason: we can't afford it.

Like most institutions - and most things in life - the NHS will need to adapt to survive. In its present form, it likely won't last. Ours is a rapidly ageing population, which will continue to rely on ever more sophisticated technologies to keep it healthy and alive.

Medicos will find it increasingly difficult to keep up with a plethora of new drug treatments - not to mention new variants of existing illnesses. Rapid advances in technologies such as nanorobotics and gene manipulation will require that GPs and nurses are constantly doing refresher courses.

Of course, new technologies will also mean a stream-lining of some services, cutting down on the time investment for medicos in some areas. For example, Skype consultations, which are already being tried in some regions, will doubtless prove time-savers when it comes to smaller complaints. Nurses may well handle some of these consultations, passing more difficult cases up to doctors.

New technologies, however, won't diminish our need of the human medical practitioner. In fact, the presence of more high-tech will boost our need and desire for high-touch. When facing an illness, we need more than a paper to read on the internet, or screen time with someone. We need the reassurance, comfort and guidance that only a highly trained, in-the-room human being can provide.

Financially underwriting a free-at-the-point-of-delivery service will become increasingly challenging. Successive governments will face a rather stark choice.

Either the NHS will need to start charging for selected forms of treatment, including those which are now offered free at the point of delivery, or taxes will need to increase. The increase may need to be a marked one, too - possibly, in the long run, to levels akin to those in Scandinavian countries.

I lived for a decade in Scandinavia and I've worked extensively there. Nations like Denmark, Sweden and Norway have excellent healthcare services, but citizens pay a high price in taxes to support them. When my family and I lived in Denmark, from the mid-90s onwards, we were paying sixty percent in combined taxes.

I'm not sure we Brits would want to contemplate such high levels of taxation, even if it meant the salvation of the health service.

I think we're more likely to move in increments toward a "free enterprise" situation, where certain treatments, which are now free, are paid for at the point of delivery. Whether that would work and on what criteria those paid-for services would be selected is up for debate.

However, whilst financial considerations are hugely important and probably central, they are just some of the issues that will decide the future viability of the NHS.

There are also important questions surrounding the core culture of the NHS.