Valerie Rose, (NHS should not be sold from under us, Craven Herald letters February 25) takes issue with the report from the Institute of Economic Affairs regarding the public response to the performance of the NHS during the Covid crisis. Whilst it is right that we should recognise the professionalism, hard work and dedication shown by staff in the NHS, the point the IEA was perhaps trying to make was that these qualities are not limited to the UK.

Have not health care staff in other countries such as Italy, France and even the USA, working in very different health care systems, also shown equal dedication?

Clap for carers started in Italy I believe as a way for Italians to show their appreciation for their health care workers

As the IEA say in their report: "It should go without saying that if the UK did not have the NHS it would not have no healthcare system. It would have a different healthcare system.” Valerie states that a healthcare system based on insurance payments would exclude those who cannot afford to pay! Really, try telling that to the Dutch. Their system is based on everyone being required to join one of several, mostly not for profit insurance schemes.

The government gives assistance to those on lower incomes and children are covered by the state.

The system is highly regulated by the Dutch government which makes sure that all parts of the system, hospitals.

GPs, ambulance services etc. work closely together to provide a seamless service whilst not themselves getting involved in the delivery. The Dutch government describe their system as 'managed competition'. Contributions are also collected from employers.

This system has managed to get cover to in excess of 99 per cent of the Dutch population.

Valerie mentions the Covid vaccine rollout and indeed the UK and NHS have much to be proud of in this respect, but the country leading the pack with over 90 per cent of its citizens given some protection is Israel. Israel also has an insurance based system, with every citizen required by law to join one of four non-profit insurance schemes, which cannot by law refuse membership.

3.1 per cent of salary or unemployment benefit is deducted and paid into the scheme and issued to the insurance groups on a pro-rata basis.

Higher earners pay 5 per cent on earnings above a certain level so contribute more in proportion.

Even the USA with its messy healthcare arrangements have managed to vaccinate 20 per cent of its population. All this suggests its not just the type of health service but the ability of the government to acquire and distribute vaccines which makes the difference.

Both the Israel and Dutch systems are highly regarded. The Dutch healthcare system came 2nd out of 35 in the 2018 European Health Consumer Index report on european health care systems (UK 16th).

Both the Israeli and Dutch systems were radically reorganised in the recent past (Israel 1995, Holland 2006) in order to face the challenges of the 21st century, we in the UK on the other hand are still working with a healthcare system basically unchanged since the 1940s.

So in reality the NHS provides a service which is better than its detractors suggest but not as good as its un-critical supporters would like to think.

So the challenge for the UK surely is how do we make our healthcare system fit for the 21st century.

Are we as a country ready to look at how the best of the best provide healthcare and see if there is anything we can learn, or will we just retreat into the bunker and shout 'privatisation' at the mere hint of anyone suggesting there may be a better way?

Andrew Diggens