Monday 17 August 2009

Improving the National Health Service

The NHS has been the main political story in recent days following comments made by Conservative MEP Daniel Hannan.

It seems that we cannot have an intelligent debate in the UK about the state of the NHS for fear of being attacked by the usual suspects on the left. “The nasty Tories want to close the NHS” is their battle cry. It was exactly the same in the 1980s and 1990s when people wanted to debate immigration. To even suggest that there should be a limit had you labelled as xenophobic or even racist.

The reality is that the NHS, as an institution, is bloated, wasteful and hugely inefficient. Nobody doubts the dedication of the doctors, nurses and other front line workers, but under this Government, billions has been poured into the ‘system’ for little or no benefit to patients and taxpayers.

Tens of thousands of managers have been employed in pointless and worthless non jobs. Billions have been spent on a computer system which doesn’t work. The public are not stupid – they know that the NHS does not deliver the quality services that they are paying for.

Don’t Call Me Dave wrote an article about NHS reform in August 2001 when Tony Blair was Prime Minster and a row had erupted over patients being sent abroad for treatment. He reprints it below:

The National Health Service (NHS) is not free. It never has been. Patients on waiting lists rightly bemoan "I pay my bloody taxes…." which is a tacit acceptance by the public that it never will be.

It is not strictly accurate to say that the NHS is free at the point of delivery either. The best we can claim is that no further charges are made at the point of delivery (although for some treatments this is also not true).

The public require a first class health service and are not fooled by a Government which cuts waiting lists by creating waiting lists for the waiting lists or cheap headline grabbing statements by the Secretary of State for Health that using overseas hospitals will be the panacea for the NHS's ills.

Successive Governments have failed to deliver on election promises to improve the NHS despite spending huge sums of public money. Advances in medicine and the corresponding rising cost of treatment and new equipment mean that resources will continuously be stretched irrespective of the state of the economy or which political party is in power. But although most people accept that the Treasury is not a bottomless pit of money, it would be a very brave person to suggest the NHS be privatised, despite even the Labour Prime Minister now accepting that the State funded system cannot cope on its own.

Likewise, even the most hardened advocates of a fully funded state system would have to agree that private hospitals are generally better managed and more efficient, and the simple solution therefore is not to send people abroad, but for the private sector to treat national health patients at public expense, effectively running a parallel service to the NHS.

Patients would be given health vouchers worth between, say, 50% - 100% of the cost of the treatment required, which could be redeemed in any private hospital on the Government's register. The need for a public register of approved hospitals is necessary to maintain the highest standards of treatment and patient care, and also to ensure that the cost of treatment is not artificially inflated simply because the state is picking up the tab.

The value of the voucher would be varied to take into account the seriousness of the condition, the patient's age and the waiting list for equivalent treatment on the NHS.

As a hypothetical example, a middle aged person with a non life threatening injury facing an 18 month waiting list for treatment on the NHS could be given a voucher worth 75% of the cost in a private hospital. The patient could then decide whether to wait for "free" treatment, or pay the balance of 25% and be treated straight away.

If the patient chose to go private, the public waiting list for those who are unable or unwilling to pay for such treatment would be reduced and the Government would make a financial saving as well, which could then be reinvested back into the NHS.

A voucher system would ease the pressure on the NHS thereby improving the morale of doctors, nurses and other health workers as well as providing extra resources within existing budgets.

It would also provide substantial economic benefit to the country. As the demand for health care continues to rise, new hospitals would need to be built creating and maintaining construction jobs and long term permanent health care employment, with a corresponding rise in income and corporation tax revenues, and a reduction in social security payments.

By sending patients abroad, public money would be lost forever, whereas if the same funds were spent treating patients in the UK, the money would remain within the economy creating further employment and tax revenues.

A voucher system would also provide a boost to the private medical insurance industry who would be able to offer a wider range of products to a much larger audience. Low cost policies would undoubtedly be developed to insure against the percentage cost of private treatment not covered by the Government voucher.

Many employers who balk at the cost of providing private health insurance for staff might now consider this to be an affordable and popular perk.

People who had previously paid substantial sums for their health insurance might now instead be offered enhanced policies providing, for example, chauffeured transport to and from hospital and private nursing at home during convalescence and recuperation.

But for all these knock on commercial benefits, the public will still be primarily concerned about receiving prompt medical treatment of the highest standard. Being treated abroad might sound like a good idea, but unless the patient is fluent in the language of the local hospital, or the doctors, anaesthetists, nurses and ancillary staff are all fluent in English, then the opportunity for confusion arises. It is one thing for a tourist to struggle with a phrase book in seeking directions to the post office, but if a patient cannot understand instructions regarding medication or is unable to describe symptoms, then there is a serious risk to health.

Furthermore, a patient is entitled to be treated by the consultant with whom they are familiar, not someone who has only read the notes immediately prior to an operation. Will the Government be willing to pay for immediate family to travel with the patient or are they proposing to send patients abroad and leave them all alone until they are well enough to come home? Does the Government seriously believe that once travelling expenses are taken into consideration, the cost of treatment will be the same as on the NHS?

Nobody is suggesting that overseas doctors are less qualified than their British counterparts, but sending people abroad is a typical knee-jerk quick fix solution which will fail to bring about long term reforms and improvements to the NHS. Health vouchers would give patients greater choice and control allowing the Government to provide faster and better hospital treatment. The patients will benefit. The Government will benefit. And just for good measure, the economy will benefit.


DarkKnight said...

One of the main problems is the money is not 'well spent'. There is far too much bureaucracy and too many layers of management. Money is diverted away from medical staff, equipment, treatment and medication.

These days, no one can be trusted to get on with a job, without multi-tiered 'supervision'. Often decisions are made by highly paid managers too far removed from the coal-face.

Private health insurance provides an alternative for those who can afford it, but not everyone can. Furthermore, private health insurance can exclude or limit certain treatments, particularly for pre-existing conditions. Once a person has been diagnosed or received treatment for a particular ailment, changing insurance companies can be difficult.

Mr Reasonable said...

In the UK we spend around 8.5% of our GDP on healthcare. In the US it is currently running at double that - 17%. You pays your money and you takes your choice. For all its faults the NHS still represents a much better option for the majority of the population. Also don't forget who were the instigators of the buraurcracy that permiates the NHS - the conservative government in 1989 when they introduced the internal market.

Anonymous said...

Mr Reasonable, the Americans do indeed pay their money and make their choice.

They pay a lot, and those who do have cover have the best healthcare in the world. This is why these people are so scared about having their choice and quality of care removed.

People should have choice. If some want to spend a large chunk of their disposable income on cars, fags, booze and holidays it is their choice. If others would prefer to top up their NHS care (ie not be forced to pay twice as Labour makes them) with their own funds, why shouldn't they? What is more moral or desirable than people spending their own money on their health?