The NHS can’t cope is now an everyday cliché. You hear it everywhere.
- Long-term conditions are becoming an ever bigger drain on budgets. Over 15m people have one or more long-term conditions. Over 1/3rd of the European population of the age of 15 have one chronic condition source WHO
- We all want more care across more conditions
- Mental health is now recognised as being as important as physical health. And the costs of mental health problems to the economy in England have recently been estimated at £105 billion, and treatment costs are expected to double in the next 20 years. source Gov.uk
- The cost of the NHS is 7.4% of GDP, but the government is looking to reduce this to just 6.9% by 2020, as part of reducing the deficit.
Why do I care?
Well the answer is that I am one of those 15 m people who are a drain on the system. I have had a chronic condition, ulcerative colitis, for over 30 years. More recently I got Guillian Barre syndrome, a rare and serious condition of the peripheral nervous system. In both cases I have benefitted from improvements in medical treatment and research, which are expensive. I recognise that when one condition gets treated another condition in another part of the system is at risk. I am equally upset to hear how some patients with cancer are not getting all the drugs that they need. I would hate to be at the mercy of the system like that. It begs the question – what should I get versus the next person? This in turn begs the question are all conditions equal or are some more important than others? This is a debate that is again frequently heard in the media – should the NHS be funding x or y treatments? Of course there are a number of media favourites including obesity, cosmetic surgery and IVF. My answer is that all conditions must be treated equally. It is impossible for the government to play Russian roulette with people’s lives in the same way as the government should not be making choices as to which companies to support and which to let fail.
If that is my answer, then the next question must be about how we make the NHS deliver this. I am unusually in agreement with some of what Polly Toynbee says in her article for the Guardian. I think we need to decide how much we shall pay to have the NHS that we want. I think it is acceptable to maintain the level of spend in the NHS, as it is the number one issue for the British people. If that means that other government issues get de-prioritised, then so be it. This is how budgeting works in every organisation. But I would introduce a long-term plan to bring more permanent staff into the NHS (full time and part time workers) and reduce the dependence on locums and extraordinary consultancy that is the bane of the public sector. I also think that we have to make other compromises.
I agree with the public and the Kings Fund that the NHS cannot afford a 7 day service. After all if we had a £2.45bn deficit in 15-16, why should we believe that we can suddenly afford to deliver 7 days a week without any new money. A survey by the BMA showed that seven in ten patients (69%) believe the NHS cannot currently afford to deliver seven-day services.
I also think that it is acceptable to increase the number of areas where people do pay for services. After all prescription charges are a form of payment and they are an acceptable compromise. I would happily accept that some additional services should incur small charges, especially for people in higher tax brackets. But we need to watch out for the law of unintended consequences, so Australia introduced charging for GP visits and saw a stampede to A&E services.
The country needs to have a more open debate about this topic. We need to make positive decisions to get what we want. If health is the biggest issue for the electorate than we need to sacrifice other things to deliver it and we need to work out a concrete long-term plan for it. We need to be in agreement about what the NHS can afford and how, for the next 50 years and not the next 5.