My wife has worked in the NHS for nearly 30 years and her stock advice to everyone these days is "either don't get ill or go private".

That's not intended as a slur on the Saintly medical staff that she works with, and for whom she has the greatest respect, but rather a comment on a Sinful system that is creaking at the seams as cutbacks push overworked doctors and nurses to the limit. When medical corners are being cut to meet budgets and targets there is a real and present danger of tragedy, and you only have to check the news to know that patient health is being compromised on an almost daily basis.

This issue has once again been brought into the spotlight by the recent revelations that a majority of GPs now favour making a charge for attending Accident and Emergency units, refundable if the visit is deemed "necessary." Of course that definition, and who applies it, opens a massive can of worms in itself.

This, of course, isn't a universally held view and is currently being resisted by the Department of Health and the Royal College of General Practitioners as a potential step towards the American approach to healthcare where those who can't afford to pay simply don't get treatment, but it's gaining popularity.

Given this backdrop you would expect that the private medical insurance market would be expanding. However, according to the Association of British Insurers, the number of people covered by health insurance fell by nearly 300,000 between 2009 and 2011. This is largely due to domestic cost cutting and reduced workforces benefiting from employer sponsored schemes, but it's a worrying trend when its something that might just save a life by getting better treatment quicker.

No one would suggest that such cover is cheap, but as with any form of insurance it's a case of balancing the cost against the alternative. Saving money is one thing, but if it means gambling with your health, that might be too high a price to pay, even in these straitened times.

Robin Sainty APFS M.A. (Cantab)