As part of an attempt to start a conversation about unpleasant and pragmatic issues around the failing health service, the BBC’s “Inside Health” on Valentine’s day 14th Feb 2017 was honourable. However, there were many issues ducked: the most obvious being that the WHO does not accept that the UK has one system any longer. Members of the medical professions will welcome the transparency and honesty of the participants, and their questioning of the “market”. The first question was on co-payments, and the last on depoliticising health, and in the middle rationing service(s) was up for debate. However, in view of the morale and gagging issues in the organisation, it was a pity that the power of exit interviews was never mentioned. On co-payments no one challenged Nick Black: “…is it to raise money or is it to deter demand”. The other good reason is to encourage self sufficiency. On Money and co-payments nobody challenged the 90% exemptions.. perhaps we could pragmatically agree that everyone pays something, whatever their means.
In the middle we heard criticism of spending on prevention without evidence, and a call for decommissioning of non evidence based prevention and screening. Post code differences, particularly in fertility treatments, were decried. When the panel called for a discussion of what was worth retaining they did not address need to be honest about what would not be available, so the issue of “overt” as opposed to “covert” rationing did not arise. Mark Britnell’s book was mentioned, but not to say how helpful it could be: Mark would take something good out of many systems, but does not hold up one as the best. Comparisons with other countries, particularly those who changed from a UK style (Everything for everyone for ever) to a rationing by co-payments and other methods was not mentioned (N.Z.) The idea that the health service is funded by those in work, and that when waiting lists are long the workers need to be treated first was not aired. The poor manpower planning and restriction of places at medical school, and the immoral enticement of doctors from poorer countries never arose. However, the panel did acknowledge the short termism of health ministers and politician’s posturing in general. They admitted psychiatry got a bad deal, but did not have time to split off the dementia component.
GPs listening might feel the panel is “out of touch” with grass roots feelings, and NHSreality would agree.
The panel was:
Clare Marx, President of the Royal College of Surgeons
Chris Hopson, Chief Executive of NHS Providers
David Haslam, Chair of NICE
Professor Sir Nick Black, London School of Hygiene and Tropical Medicine
Margaret McCartney, Glasgow GP
Programme Transcript – Inside Health from the BBC
What would the world’s best health system look like? Mark Britnell