We need to talk about ‘our’ NHS. It is quite clear that it is at breaking point and fundamental reforms are needed to ensure its survival. And yet anyone who dares to say so runs the risk of inciting hysteria.
Hospitals in England are severely understaffed. A report this week by the Commons Health and Social Care Committee revealed that we need 12,000 more doctors and more than 50,000 nurses and midwives.
By the early 2030s, the NHS is expected to need 475,000 more workers, and 490,000 more jobs for carers.
But these services are already under a lot of pressure. One in three carers left work last year and the number of full-time GPs has fallen by more than 700 since 2019, with the majority now only working part-time. The average waiting time for an ambulance is 51 minutes.
‘Hospitals in England are severely understaffed. A report this week by the Commons Health and Social Care Committee revealed that we need 12,000 more doctors and more than 50,000 nurses and midwives.
Yesterday’s Mail told the harrowing story of a 61-year-old heart patient, himself a retired GP, whose husband drove 300 miles from Cornwall to London in search of a hospital bed after suffering chest pains. Traveled to
Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College.
Grief and anger
We can’t just go like this. Following the pandemic and its impact on healthcare delivery, there are a record 6.6 million people on NHS waiting lists in the UK – and the number is rising. This is unsustainable and we need to deal with it.
But how? It is of course extremely unhelpful that any attempt at dialogue on the future of the NHS is met with anger and panic from those who believe it is blasphemous to even consider alternative ways of funding the system. to do
They claim to defend ‘our NHS’ by refusing a facelift and instead insist that any problem can be solved with ‘more money’. But perhaps ironically, they are killing our health system with this demand.
If we can just have an open discussion about the alternatives out there, people might realize that the status quo may not be the best option. There are several internationally recognized alternatives that can help us. One — which I raised in a new book published this week by think tank Radix UK — could be ‘hotel’ charges for hospital admissions, as in the German and French models, where patients pay a nominal fee (around £8 per night) pay. A bed.
I wasn’t necessarily advocating this as a policy but one of several options we could consider as a starting point for discussion. Nevertheless, it was greeted with outrage in some quarters. It is somehow seen as almost unpatriotic to point out that many developed countries have health services that are in some respects better than our own – more efficient, shorter waiting lists. , more beds, better outcomes for cancer and other diseases.
‘By the early 2030s, the NHS is expected to need 475,000 more workers, and 490,000 more jobs for carers’.
But we have to face the facts. The NHS is almost 75 years old. All this time, it has been financed centrally through taxation and, no matter how much money is poured into the service, it is never enough.
Every other aspect of life in Britain has changed radically in these seven-plus decades. It is illogical for us to keep the aged health service wheezing on life support.
Let me make one thing clear, though: Whatever new funding models we add, we can never adopt the American system of individual health insurance policies that drive up prices for low-income people. No country should suffer the consequences. It is also true that there is no perfect health care system anywhere in the world. All of them have advantages and disadvantages.
A straightforward approach would be to introduce a fictitious tax, which is levied specifically to raise funds for the NHS.
This was considered by Jeremy Hunt when he was health secretary, who proposed a ten-year funding plan with tax increases targeting older workers.
Another idea was to pay National Insurance to the 1.2 million pensioners who continue to work past retirement age. Both schemes will be hugely unpopular with people who have already spent their working lives paying tax, as will proposals to end universal free prescriptions for the over-60s.
The graph shows NHS England’s waiting list for routine surgery, such as hip and knee operations (red line), reached a record high of 6.18 million in February this year.
In April this year all workers started paying a 1.25% rise in NI payments, the Health and Social Care Levy to help tackle our social care crisis. But such money is never fenced off, and at least for this year it is said to be going towards reducing the Covid-related backlog. How much of that money is likely to reach social care is anyone’s guess.
Indeed, the real problem with earmarking specific taxes is that governments will always be tempted to raid them for other, more immediate purposes.
We have to be more innovative. We are a nation of endless resources and innovation. Improving the NHS should not be beyond our collective powers.
For example, we could potentially increase the number of co-pays — as we already pay for prescriptions and dentistry.
These fees can be retrospectively means-tested and refunded to low-income earners. And elderly or long-term patients can also be excluded, ensuring that any additional costs will only fall on those who can actually afford it.
I believe it will be more popular than a tax increase. And, importantly, we know it can work, because it’s already common practice in Europe.
The figures show how NHS bed occupancy has changed during the pandemic.
The French pay a similar fee to see a GP. This discourages time wasters with frivolous complaints and frees up more appointments while reducing pressure on doctors. And, of course, the fee is refunded for those who are unable to pay.
I would expect up to 90% of patients to be eligible for reimbursement, just as in England only 10% of people who collect a prescription actually have to pay. The vast majority are exceptions.
A counterargument is sometimes made that successful cancer treatment often depends on early diagnosis and anything – such as an upfront fee to see a doctor – that makes people less inclined to get a checkup is risky. . But the figures also show that cancer outcomes in France are actually better than in the UK.
The French and Germans also have much better levels of acute hospital beds than we do. But the Scandinavian countries don’t – and their healthcare is often considered the best in the world.
Sweden and other Nordic countries have excellent social care services that enable them to prevent many problems before they require hospitalization. But everything comes at a price and the Scandinavians pay far more in taxes than we do.
At the height of the pandemic, Britain finally recognized an important factor – the role of our outstanding medical staff. Doctors, nurses and other care workers perform some of the most difficult tasks imaginable. It makes sense to reduce the stress and pressure of their lives wherever possible.
If we don’t, many will give up out of exhaustion or frustration – as they already do. The treadmill for GPs, expecting a consultation every eight minutes to an hour, is inhumane. It takes up to 15 years to train a doctor. Anyone who leaves the NHS is a serious loss.
We cannot keep shouting ‘I love the NHS’ and hope that only love will save it. This week’s cross-party report goes a step further. But it has to lead to an unbiased, honest debate about the future to have any real impact.
People can disagree and fight for what they think is the best way. After all, there is no single answer to the crisis in the NHS. But one thing is for sure – the system is breaking down and blindly throwing money around will not fix it.
- Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College.