BY ANASTASIA CHOO
Country Squire Magazine’s Anastasia Choo works in the NHS and is a proud supporter of Britain’s Health Service. Here she discusses why we should keep the NHS and suggests we all wake up to the reality that if we want a successful and effective healthcare service now and in the future we need to pay more, keep fit and waste less.
The new year has kicked off with 65 out of 122 NHS hospital Trusts in England warning they need action to cope with patient numbers. Figures show that forty-two A&E departments ordered ambulances to divert to other hospitals last week, patients have been left on trolleys in corridors waiting up to 36 hours and routine operations have been cancelled to free up bed space.
The knee jerk reaction to these problems is always to play the blame game. The tax payer is quick to highlight that we have a bloated NHS with non-clinical pencil pushers drawing fat cat salaries, who do not save lives but make poor decisions. There is some truth in this – under New Labour the NHS entered into Private Funding Initiatives (PFI) to build new hospitals which has left the NHS bleeding £3700 per minute to repay the costs with interest over thirty years. But the tax payer must also accept that it takes more than doctors and nurses for the NHS machine to function – a myriad of personnel is needed.
The Chief Executive of NHS England, Simon Stevens, is in a war of words with the Prime Minister over issues of funding in real terms and the fact that there will be a £30 billion budget gap by 2020. On the other hand, the Office for Budget Responsibility, the OBR, has calculated that unless the current productivity rate in health improves, the cost of the NHS will push the national debt to more than 200% of GDP by 2060.
The Red Cross has likened the problems in the NHS to “a humanitarian crisis”. Whilst that is an exaggeration, there is indeed a cataclysmic crisis looming and it cannot be dismissed as just “a typical winter” by government. Nor was it prudent of Theresa May to urge GPs to operate a seven day GP service between 8am to 8pm – in effect blaming GPs for the problems in hospitals. GPs have responded angrily that they have been over-stretched for years and are being used as scapegoats.
Despite these problems, the NHS is still ranked as a number one health care provider globally, formed in post-war Britain to offer free health care to everyone at their time of need and financed entirely from taxation. It is one of the few state institutions that British people are genuinely passionate about, to the extent that an NHS bed ballet formed part of the opening ceremony at the 2012 Olympics.
Within a year of its formation though, demand exceeded predictions, the NHS budgeted for £1 million for Opticians, by the end of the first year 5.25 million spectacle prescriptions plus other work produced a bill of £32 million. The NHS has proved expensive to run and successive governments have tried unsuccessfully to reform it and to balance the books. This has been the financial situation since the 50s; either we contribute more to pay for demand or we cut back on usage and limit services. Neither of these options will go down well with the public but the truth of the matter is that it’s come to crunch time and a choice must be made.
The blame game needs to end and we as a nation should have an open, likely uncomfortable discussion about the NHS. We need to pay more NI contributions to reflect the increased relative cost, whilst addressing the NHS’ many existing problems if we are to maintain the free service.
For one, we need to review which services are essential and which ones the tax payer could do without paying towards. The range of services and treatments available on the NHS has increased over the years. Up until recently, patients could get breast enlargements – yes, a boob job, by claiming mental stress and poor body image affected their sex lives!
It is a step in the right direction that the NHS is clamping down on non-essential procedures and we need to continue to limit the range of treatments available “free at the point of use” and charge the full cost of anything not covered within the limited range.
The NHS also spends millions on dealing with “lifestyle illnesses” associated with obesity, smoking, drinking, drugs and sexually transmitted diseases. Should the tax payer be responsible for funding the poor lifestyle choices of others? If patients were presented with an invoice to highlight the costs of their damaging lifestyle, would they abuse their body in this way? This could be one possible way of tackling lifestyle illnesses which are currently a big drain on the NHS. Perhaps it’s time patients met the costs for at least half of their treatment? However, some might say that this is verging on the lines of the government making morality judgements on its citizens. How would we ever decide which conditions are eligible for treatment and which ones are self-inflicted and not deserving of NHS treatment?
The issue of bed blocking has been brought to light in the media recently and has been a source of much public outcry. The problem is two-fold: the lack of clinical personnel to process the patient discharge often means the patient remains in hospital for longer than necessary; lack of a place of convalescence for the patient to go to also means they are forced to remain in hospital. It costs the NHS over £1k per patient per week’s stay in hospital; some patients have waited up to thirty days to be discharged into residential homes. Social Care, although separate from the NHS budget, needs to be more readily available to help with the speedy discharge of elderly patients and in turn free up hospital beds. We must also reduce the bureaucracy involved to organise a social care package needed for an elderly patient.
As it currently stands, we as tax payers feel that we have already paid into the NHS system and frown upon paying for more towards it. The cost of missed appointments on the NHS stands at £1 billion per year. We need to accept responsibility for wastage too and not frown at the idea of paying a fine for missed appointments. Patients should be charged for missed appointments, say a nominal fee of £10, as dentists have had this in place for some years now. Patients are also unaware of the costs of medication and need to take care not to lose their medication, as the true cost is often more than the £8.40 paid per item at the pharmacy. Furthermore, nobody should be requesting paracetamol or ibuprofen on an NHS prescription when a pack of 16 tablets could be bought over the counter for as little as 28p. The cost of issuing paracetamol per year costs the NHS £80 million.
These are just some of the problems which the NHS is facing. The government is reluctant to ask the public to pay more into the system as it’s not politically palatable. The public is frustrated with the standard of service they are delivered after paying their taxes. But we all need to wake up and face reality; the system as it stands is crying out for more funding, current budgets simply cannot cope with present demand. We could ignore the problems in the NHS, shy away from having this awkward conversation about paying more into the system and settle for an eventual rationing of services or even privatisation, which would be detrimental to all. Or we as citizens could take responsibility and pay just a little bit more to make our NHS run more efficiently. To do otherwise, we would all be doing ourselves a disservice as stake holders in the equitable health care system we have which is envied worldwide and helps make us the proud Brits that we are.