An NHS in crisis
The UK public requires a new deal with the NHS, becoming a safety net and not necessarily the sole healthcare provider for its citizens.
Dear Prime Minister
The NHS is in crisis. Labour’s and Wes Streeting’s policies on the NHS make little sense and will make things worse. The UK needs to look at other healthcare systems for inspiration. Adopting a sledgehammer or chainsaw to cut costs and drive efficiencies in the NHS will not work. For example, cutting costs by reducing the number of NHS managers to improve productivity will fail. The NHS is one of the most undermanaged healthcare systems in the world. The NHS needs more managers, not less.
From an evolutionary perspective, organisms or by analogy organisations that have more meat and fat on their bones are much more likely to be able to adapt to changing circumstances. Those who have had all the fat and muscle removed and reduced to a skeleton are likely to die and go extinct. The NHS is on its way to becoming a skeleton of its former self.
The pressure on healthcare expenditures will only increase as the population ages and cutting-edge but expensive innovations emerge. Healthcare inflation, from a historical perspective, has always been higher than general inflation, and this is unlikely to change. The NHS will consume an ever-increasing proportion of the Government’s budget in the future. In addition, a significant component of healthcare will become lifestyle-related. It could be consumerised and paid for privately, reducing pressure on the NHS. This is already happening with the new generation of weight loss drugs. The majority of prescriptions for the GLP1 agonists are in the private sector. Therefore, rationing to control healthcare supply and demand is not working and will not wash with the general public. Thus, the only solution is to shift a substantial proportion of healthcare expenditure into the private sector and away from general taxation. To do this, the government must be bold and implement incentives to allow private healthcare to flourish.
The world's most successful and flexible healthcare systems have private and public funding, and more importantly, better healthcare outcomes. Adopting a dual funding model does not have to compromise the founding principles of the NHS, i.e. universal healthcare that is equitable and free at the point of care. Personal incentives are needed for individuals to take out private healthcare insurance. Why not make a proportion of private health insurance tax deductible, or a proportion of funding for private healthcare portable from the NHS, with individuals having to pay a top-up for private care? These incentives will allow a significant proportion of healthcare to transfer to the private sector and relieve bottlenecks in NHS care.
Yes, the private sector will cherry-pick the lucrative elective work, but I predict the more enterprising NHS providers will set up and run private arms to supplement their NHS income. A downside would be the potential impact on training, but this could be accommodated by including the private sector in training programmes. The effect on training is theoretical, as countries with dual healthcare systems don’t seem to have any problems training their next generation of healthcare professionals.
People don’t like paying more tax for a public service that fails them. They are more likely to start paying for private healthcare if it is incentivised and doesn’t compromise their access to NHS services if they need them. The UK public requires a new deal with the NHS, becoming a safety net and not necessarily the sole healthcare provider for its citizens.
I would recommend a public consultation on the future of healthcare in the UK to determine the best way of providing an affordable but universal service that doesn’t compromise the basic tenets of socialised healthcare. I am convinced the public would support a dual funding model that works well in many other countries. During this consultation, the public will also realise that most of the NHS has already been privatised, but not the option of choosing your provider.
I look forward to hearing from you.
Professor Gavin Giovannoni
A concerned healthcare professional with complex medical needs of my own.
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General Disclaimer
Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional, who will be able to help you.
Dear Gavin,
As is often the case, I agree with your sentiments! As an OT for over 40 years—now retired from the NHS—I have sadly watched its demise over many years, to the point I could no longer work within it! I cannot change the philosophy or organisation of the NHS, but I can no longer work in an institution I do not believe in.
In my opinion, one way to secure healthcare staff for the future would be to pay for training for the professional degree courses, in exchange for an agreement of 5 years' service (obviously paid).
Additionally, some countries, such as Austria, for example, provide healthcare/pension with a green card. It is expensive, at around 400 euros per month, but not all expenses are included with this card. If you require a hospital stay, your meals are required to be paid as an 'accommodation fee ' at around 15 Euros per day—an estimation of what you would spend per day at home on meals.
You can walk into a GP surgery and be seen that day. For example, when visiting a hospital, residents either present their Green Card or credit card before being seen. Prompt payment for a service they will receive!
Efficiencies could be made in many ways, but I agree that a substantial organisational change is required.
As a dual Australian/British citizen who has lived in both countries as an adult, I was saying this about 35+ years ago when I was first living in the UK, I could see what was happening even then, but was shouted down by my friends who were absolutely wedded to the idea of the NHS. Since then the decline of the NHS has accelerated, especially over the past 10-15 years.
I reflect that when I was first suspected of having MS, it took me 2 weeks to see a neuro, and then less than a week for the MRI, yes I had to pay about 30-40% of the cost for the appointment and MRI, but there is also a safety net for people who can't afford it. After diagnosis, I then got to choose any of the medications I wanted which cost me $AU35 per prescription (private price $26000).
I compare this to some of the waiting times my now elderly relatives are having to wait before they even get in to see a specialist for the first visit in the UK of 6 months or more.
The NHS was an amazing idea at the time, but health care has moved on so much and is so much more expensive, and many more people are living for much longer, it really can't cope, Nye Bevan would be turning in his grave.