Like me, the NHS celebrates its 70th birthday this year. For the first half of its life, it was a shining light in a world, recovering from the ravages of two world wars. For the British it meant that everyone, irrespective of their wealth, from the very poorest to the very rich had free access to the best healthcare available anywhere in the world. We were at the forefront in eradicating many of the diseases, with which previous generations were afflicted; polio, rickets, diphtheria and tuberculosis, to name but a few. However, during the second half of it’s life, the healthcare systems in many other countries have caught up and overtaken our NHS, which has been slow to adapt to the demands of today’s fast changing world.
So what’s the problem? Why has our NHS fallen behind and why does it seem to lurch from one crisis to the next? This is quite obviously a very complex problem and impossible to answer in a few short paragraphs. But, if we are to resolve the NHS issue, there are a five basic factors that, as a nation, we need to get our collective heads around.
The first is that, whilst more money may provide some short term help, on its own, it will not solve the problem. It will merely defer the underlying need for radical change. The fundamental problem is that the model on which the NHS has been built, is no longer fit for purpose.
The second is that the NHS is quite simply too big. It is the largest civilian employer in the world, employing around 1.4 million people. In managerial terms, even with modern technology and the best managers available, its size and complexity make it impossible to manage efficiently. That’s not a reflection of the abilities, commitment or integrity of the people running it, it is a case of what is or is not humanly possible.
The third is ideology. As a nation, we have become entrapped by the belief that the NHS must be entirely publicly owned and publicly funded with no role for either the not-for-profit or private sectors. This has now reached the ridiculous extent that the outsourcing of some services to the private sector is seen as privatisation; and the involvement of charities is seen as failure. As a result, the NHS forgoes the opportunity to fully utilise both additional capacity that it needs, particularly in the winter months, and additional skills and expertise that it doesn’t have. If you’re seriously ill, you don’t much care who owns the hospital you’re in or who pays the doctors and nurses. What you do care about, is that you’re getting the best possible treatment for your condition, and that it’s free at the point of delivery. Ideology is a luxury for the majority of us who aren’t ill.
The fourth issue is political interference. This applies to governments of all political parties. Few, if any, of our 650 MPs have any significant experience of running large complex organisations. But they cannot stop themselves from interfering. We have seen governments of all colours driving through one disastrous re-organisation after another. And they keep getting it wrong because they are, quite simply, out of their depth. We really must find a way of de-politicising the NHS and of establishing it as a self governing organisation, working under the terms of a charter, similar to the BBC. Under these circumstances, the government’s role would be to set the basic parameters under which the NHS operates and then stand back and allow a properly experienced and qualified board to run it.
The fifth issue is funding. At the moment, the NHS is funded top down. In other words the government decides on a budget and that money is divided up from the top down. So, there is a scramble for funds all the way down the chain from national, to regional, to healthcare trusts, to individual hospitals, and eventually to the departments actually delivering the services. Under these circumstances, the likelihood of every department of every hospital or healthcare trust receiving the right amount of funding to enable them to deliver the services that their local communities requires of them, is about as likely as me winning the jackpot on the lottery. We need a bottom up system that means all healthcare services receive payment for what they actually deliver. So, if a person is in hospital for an appendectomy, the hospital is paid for an appendectomy. If it’s cancer treatment, the hospital is paid for cancer treatment and so on. This means that the size, structure, staffing profiles and investment decisions of hospitals, healthcare trusts GP practices etc are governed by the actual demand coming from the communities they serve.
If we look at healthcare systems in Western Europe, few, if any have the problems of our NHS and many are well ahead of us in terms of both service and outcomes. Countries like France, Germany and Sweden all have different systems; but they all have certain things in common. They are all much more decentralised with considerably greater local autonomy. They all involve private sector and charitable trust facilities in conjunction with publicly owned ones. And generally, funding is bottom up through some form of insurance based mechanism. In the UK, the idea of an insurance based system raises howls of anguish; but if it helps deliver a better service we really do need to consider it. But we also need to start thinking outside the box about how it could work and continue to safeguard all of the vulnerable groups in our society, for whom a conventional insurance system would present a major problem.
If we are serious about providing everyone in the UK with a world class healthcare system that is free at the point of delivery and fit for the 21st century, we cannot continue to remain wedded to an outdated healthcare model that is edging ever closer to collapse. We need to approach this problem with open minds that are not blinded by political ideology and we need to look at best practice in other countries and learn from them. It’s a huge challenge but unless we start to face up to it, the position will continue to deteriorate no matter how much money is thrown at it.