The Times leading article 14th March 2015 reads: Saving the NHS – Political parties are in denial over how to fund the growing pressure on the health service. We need an honest debate about new means of paying for it – addition 16th March – NOBODY is brave enough to save the NHS
&E won’t kiss it better,” say the bracing but necessary advertisements on London buses. Unfortunately, A&E won’t necessarily save your life either, not for want of expertise or compassion but because of a fundamental mismatch between supply and demand that afflicts
the entire NHS.
The service is in the grip of a four-pronged vice of ageing patients, ever-costlier treatments, rising expectations and acute pressure on budgets. Everyone who debates health policy in parliament knows this. There is surprisingly little disagreement on the basic priorities for improving care, from better co-ordination between hospitals and care homes to the need for more resources. What no main party leader dares discuss is where those resources must be found.
The business model of the NHS is strained beyond repair. At a time when half of us will develop cancer sometime in our lives and cutting-edge drugs can cost £50,000 per patient a year, a world-class health service free at the point of need, funded entirely from direct taxation, is not sustainable. If the next government is serious about preserving the NHS it must level with voters about the need to find new ways to fund it. The approach need not amount to privatisation. However, it will have to borrow from the best systems in other countries. Most deliver better outcomes, especially in the treatment of serious illness. All are insurance-based, with charges in some cases for hospital stays and doctors’ visits. As a result they are better able to keep up with demand. The NHS is a wheezing laggard by comparison.
Bleak new statistics from the nation’s ambulance services illustrate the point. Responses to freedom of information requests by The Times show that the number of patients with life-threatening conditions forced to wait more than an hour in an ambulance before A&E treatment doubled last year. The number who died before even being admitted to an A&E department tripled.
Ambulance queues caused by unnecessary callouts are one reason for this trend. Others include ill-advised referrals by the 111 health line, overstretched A&E staff, inadequate or non-existent out of hours care at GP surgeries and weekend bottlenecks when elderly patients with chronic conditions end up at accident and emergency for want of timely residential care.
Labour would have voters believe the NHS is on life-support and about to be sold off for scrap to the highest bidder. In fact sensible research by the King’s Fund think-tank has given the lie to the privatisation myth. Barely 5 per cent of NHS services have been outsourced to the private sector. Nor is money a panacea, yet there is no doubt that more of it is needed. Even Labour’s campaign promise of £2.5 billion a year more than the Tories falls far short of the extra £8 billion a year that Simon Stevens, the current NHS chief executive, says is needed.
Without funding on this scale the service will face a £30 billion shortfall by the end of the decade. To bridge it, brave thinking that shatters old taboos is needed. As Mr Stephens has written in this newspaper, the health service cannot be a hostage to its history. But that is what it will be unless politicians find the courage to stop worshipping the service and rethink it for the modern age. For five years David Cameron has himself been hostage to his three-letter health policy (“NHS”). Labour is so deeply in thrall to the status quo that this week it forced the Commons health select committee to scrap an NHS report for being too supportive of the coalition.
The health service consumes less as a share of GDP than comparable systems abroad, but it ranks poorly on keeping people alive, it is over-politicised and it is heading for insolvency. The prime minister who works out how to pay for it will go down in history as the one who saved it.
The comments on line are impressive but NHSreality has it’s own. I apologise to The Times for reproducing in entirety but regard the subject as too important to omit.
It is an acceptance by politicians of the need to ration heal care overtly which will change the dynamic and the debate. One method of rationing is by co-payments. Once co-payments are seen as a good and encouraging autonomy for the smaller cost items, then we can have the much needed debate. Unfortunately rationing by knee jerk introduction of copayments without the debate can be destructive, as there are many methods to ration. Some goods and services are so cheap that everyone, whatever their means or abilities should pay for them. Paracetamol, verruca treatments, worms… And payees need to include the elderly – only those without means should be subsidised and that by delayed repayment. Everyone using their regional health services should be aware of every cost, and of what is not available in advance. The methods of covering the deficit should be explicit, and possibly tax deductible. Places at medical school should be increased, with equal numbers of men and women graduates, and the 10 out of 11 applicants currently rejected should all get places if they are capable of doing the subject.
Overcapacity leads to choice, and longer term strategic options, which include manning the health services with people with UK language and cultural awareness. Limiting places at medical school is one of the most perverse methods of rationing.
Correspondence in The Times 16th March 2015:
We need an honest debate about new means for paying for the NHS, but few politicians appear to have the courage to advocate revolutionary change
Sir, Your leader’s analysis of the problems facing the NHS is spot-on, and the suggestion that the additional financial resources required should be found outside general taxation is absolutely correct (Mar 14). Insurance-based and co-payment schemes work well in many other countries with superior health outcomes to the UK, and neither amounts to privatisation. Those more able to pay for healthcare simply pay more.
This is an enormous “elephant in the room” in any discussion about the future of the NHS. Let us hope that, although no one is likely to debate it before the election, the next government has the courage and gumption to bring into the open a discussion that everyone knows needs to take place, and which must take place if a national health service is to be preserved.
Professor Roger Jones
Editor, British Journal of General Practice, and emeritus professor of general practice, King’s College London
Sir, Your leader on the financing of the NHS was a courageous statement of the obvious. I have known the NHS from its inception, for 50 years of this period as GP, and it has always been underfunded. Innumerable reorganisations have done no more than scratch the surface of this problem.
The reason, as you imply, is that the NHS has become a national religion, and those who adopt the view that the service is sacrosanct cannot be persuaded. There is abundant evidence that there are better alternatives, and no nation ever has, or ever will, provide everything which modern medicine has to offer, free and at the time, to the entire population. Several other countries have better outcomes for longevity, survival rates for common cancers and numerous other indicators. Their systems often depend on an insurance-based scheme and some payment at the time of attendance for those who can afford it. If such schemes are well devised, they need not involve the withholding of care for the less privileged.
It would take brave politicians to advocate such a revolutionary change — and the prospect of this happening does not seem likely until things inevitably become far worse.
Dr Brian Posner