The future of the NHS - a vision of how the provision of health care can be taken forward despite today’s financial constraints, yet still delivering care free at the point of contact.
The NHS is a vast, bureaucratic, unwieldy machine “bettered” only by the Red Army and Indian Railways.
The resources of the NHS are finite.
Patients expect more and more.
Medical advances mean that more and more is possible.
As resources are finite, it is inevitable that all that might be done cannot be afforded.
Choices have to be made about what the NHS will provide, and what it will not.
Health care must remain free at the point of contact.
If the NHS has to pay for an operation, what difference does it make if it does so by paying for it do be done in an NHS hospital or in a private hospital, as long as the costs are the same? In fact this is already happening. So what is the difference between these two providers, the NHS hospital and the private hospital? Only the label.
If I insure my house or car, I get a contract from the insurer stating what is covered and what is not. Further, it states that I must take reasonable measures to look after my property by locking the house or car when I am not in it.
We insure our health with our National Insurance contributions, but we have no contract. We are allowed to abuse our health in almost every way, and the NHS will still pick up the bill.
This surely is an issue that needs to be addressed.
Other input:
I have been persuaded recently that privatisation and competition is the only way to improve efficiency and service. The question is, how can that be done while still keeping care free at the point of contact?
The answer:
We adopt what is essentially a private health care system, but the government pays our subscriptions. What I envisage is this:
We pay National Insurance as at present. When we see a doctor, we are not charged. Very little seems to have changed.
There are insurance companies to whom the government pays our subscriptions on our behalf. There are several of these companies, and we shall have a choice which company we want to use, but we will not personally pay them any money. That choice of company is the only change the patient will perceive.
There are health care providers e.g. hospitals. Those that are currently NHS hospitals will become private businesses. They will charge the insurance companies for their services, along with those that are private hospitals today.
General practices will work also as health care providers, and charge the insurance companies for their services.
The providers will compete to provide the best service at the best price, so that the insurance companies will choose to do business with them. The insurance companies will compete to offer the best deal to their patients. Patients may then be aware that one company has advantages and disadvantages over another, e.g. long waiting times but better treatment when you get it. Patients will choose the company that seems to best meet their needs.
Because there is a limited resource, the core services that have to be provided will have to be clearly defined. For example, it may state that out-patient appointments must be provided within a specified time, and that those requiring hip replacements will be offered surgery. The core services may not include tattoo removal, water births, or the prescription of certain expensive drugs when others are adequate.
All patients will be entitled to receive any of the services contained in the list of core services, and all insurance companies will be required to keep their side of the contract, and purchase those services from the providers.
Patients may also, if they choose, buy add-on policies from their insurance companies that would insure them for extra non-core services, such as more luxury, the more expensive drugs etc. The insurance companies would then weight the fees for the add-on policies according to how well the patient looks after himself. There would be lower premiums for non-smokers who look after their weight, and higher premiums for the inactive, obese smoker who continues to enjoy his deep-fried Mars bars.
The advantages:
Health care continues to be free at the point of contact.
All usual needs will be met.
The patient is empowered to take his business to whoever will best meet his needs. This will spur the insurance companies to commission quality service from the providers. This in turn will have an impact on the quality those providers offer.
Thus the service will be improved.
The government will no longer be involved in health care policy; they will only pick up the bill.
On this last point:
It has always been a problem for the politicians to want aspects of the service to be improved, and yet they hold the purse strings. Further, they find it impossible to make unpopular decisions. In the same way that the Bank of England was freed of its shackles and given its independence, they could do the same for the NHS. Much government time would be saved. All they would have to do is to agree each year how much to put up the total spend. The private sector would then decide how to spend it, with the patients deciding which insurance company is doing it right, and they in turn pressuring the providers to do it right.
So when someone asks the PM, what about (e.g.) waiting times, he can reply, “Why are you asking me? We don’t run this anymore.”
And when it comes to electioneering, the various parties will have policies on how much to increase the budget for our consideration, but no more initiatives aimed purely at votes.
The disadvantages:
For patients, they may have to think about where to take their business.
And they won’t get their tattoos removed, or a home water birth, or a more expensive drug than the perfectly adequate one they have been prescribed.
And they may have to put up with mail shots offering them better services.
It’ll be tough !!
For GP’s, consultants and hospital administrators, it could be very tough.