Two-way tug on merged budget for health care

What is wrong with the National Health Service? Not much, according to health secretary Alan Milburn, who says that Labour has met its 1997 election promises on health and is moving on to yet higher standards. Quite a lot, according to this week's survey from the World Health Organisation, which ranked the United Kingdom 18th in terms of effective health spending, behind Portugal, Oman, Singapore and others.

The survey reveals that in the United States, market forces in health mean big bills and poor results. It comes 37th in the WHO's league. Few can doubt that the immense cost of gaining medical qualifications in the US is a factor that compels even responsible and gifted doctors to maximise their incomes. In the UK, the new medical schools and medical training places now coming through (back page) will mean more doctors, one prerequisite for a better NHS. But despite the stiff competition to train these new doctors, there is a risk that the institutions accepting them will face a financial burden for doing so.

In the past the double act between the NHS and universities to fund medical education, including the Service Increment for Teaching, has lacked transparency but saved on paperwork. People knew what their jobs were and the system saw that they were funded by one channel or another. As the system expands, a number of such funding routes will merge into a common stream for all health professionals.

One worry is that this funding stream may be targeted for the same "efficiency gains" as the rest of higher education, especially with constant pressure for more front-line NHS care. It also offers too little support for research. The fashion for evidence-based methods means that doctors will need new research skills. New technology - topically, in human genetics - will need capable researchers to make the most of it.