Don’t Give Up on Our NHS!

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.

20 thoughts on “Don’t Give Up on Our NHS!

  1. The choice is ours – remain as we are from crisis to crisis within the NHS and a postcode lottery for treatment due to restriction in funding or pay a little more. We could of course, flirt with insurance contributions but the NHS would no longer be a universal healthcare system free at the point of need and fair for all. Champagne for all would be better!

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  2. Anastasia, I agree, we as a nation should take better responsibility with our health, lifestyle and demands we place on the NHS. If we pay “Beer money, we cannot expect a Champagne service.” So either we pay more via NI contributions or the Govt increases its expenditure on health, neither popular but necessary to make efficient the NHS.

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  3. I said what I said – that the claim “…. the NHS is still ranked as a number one health care provider globally” was highly selective. In many instances it isn’t.

    And all the surveys I have read indicate that cancer survival rates are amongst the worst in Europe, and THE worst in W Europe. I don’t call that good.

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  4. Dear Maraia,
    Thank you for highlighting this and as you mention Europe – yes, the Wanless Report ranks us lower than some European countries. It highlights that countries such as France and Germany invests much more into their healthcare system and Britain has been underfunded for some years. They also have a dual payment healthcare system which combines taxation and personal insurance cover whereas the NHS is financed through NI contributions alone.
    It did however, conclude that the NHS funded through public taxation was the best way to provide fair, efficient and economic health care.
    As government does not have a limitless pot of money to spend, surely increasing our NI contributions a little together with continued reform of the NHS could help us maintain the equitable healthcare system that we have.
    With regards to cancer survival rates, many factors such as age, type of cancer and lifestyle would affect the outcome.
    Goodnight.

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  5. Maraia, are you saying you want an insurance based healthcare system such as our European neighbours where access to treatment is calculated on amount of cover vs our single system one way based NI contributory NHS system which is fair for all? As for cancer survival rates, altho lagging behind some European countries, overall they are good. Plus, you need to factor in lifestyle habits such as drinking, smoking n diet in the UK.

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  6. “…. the NHS is still ranked as a number one health care provider globally”

    Not so fast. According to the Commonwealth Fund assessment, yes, but according to a recent European survey, it came 14th. Pity you left that out.

    Cancer survival rates leave much to be desired as well.

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  7. Well written article and obviously from a well informed position. Lawmakers in the U.S. can learn a thing or two from the process experienced in the U.K. about public health care.

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  8. Hi Anastasia
    May I firstly commend you on such a well written article. A very interesting read indeed.
    I agree that the NHS needs to be maintained and if that means the tax payer contributing more via NI contributions then so be it.
    I’m sure many of us would loathe a system like the USA where unless you have adequate insurance you will not receive medical care. As the American gentleman commented earlier he wishes the States had a similar service.
    I accept there are many complaints against the NHS but personally speaking as someone who has needed to use it many times for a variety of reasons I cannot praise it high enough.
    I also agree with your comments on ‘lifestyle illnesses ‘ but invariably those people do not think about cause and effect.
    Welldone once again on a great article!

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  9. Hi Tim, apologies, i didn’t see this, right at the bottom of the other comments. Wow! You read my article at 1:22am as soon as it was released. Truly flattered:) Judging by the comments, i’d say most of the public or at least CSM readers are passionate and care about the NHS. Couldn’t agree more, government should not be afraid to reform the NHS no matter how unpalatable politically. Not sure that over stretching services is the answer and i do think it’s high time we took a little more responsibility whether it be via increased NI contributions or using the NHS sensibly. Good day. ps i’ll save my thoughts on the brilliant job that Nurses do for another article. Thanks again!

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  10. Interesting read! Strongly agree with the ‘Lifestyle Illnesses’ being a huge, unnecessary drain on our limited resources within the NHS! Also agree that it would be hard to decide where to draw the line between self inflicted and the contrary.

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  11. Hi Anastasia. You’ve touched on the darling of the UK’s post war restoration. Away from a Colonial power and into more socially inclusive one. Though not without issues. Over time great institutions find themselves having to re-invent themselves to help them to remain relevant in the current era, the current epoch even. Up to a point, The Queen has pulled this off wonderfully with the UK Monarchy – the NHS also appears to need something similar, each winter controversies abound. I pray for the really young, the elderly and the vulnerable that the country can keep a free at point of use service… Karl

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  12. Dear Grimbler,
    Thank you for reading my article, good try, I’ll take that as a compliment. I am shocked to hear that your friends working in the health service report such malpractice, unnecessary operations? I suggest you provide evidence if you are to make false allegations! Shadow any GP and you will see that they work beyond 9 to 5, it’s more 8am to 9pm without any breaks. The number of female GPs has increased because I am sorry to inform you but there aren’t enough boys obtaining the grades to be accepted into medical training. Those that do, may not choose GP work. It does not however, mean that female GPs should be penalised for choosing to work part time nor penalised for raising a family at the same time. Puzzled why you think the NHS should operate any differently to other organisations with various levels of management and personnel. I don’t know of many companies that operate without a Personnel Dept to ensure employment laws are adhered to. Agreed, government and some NHS execs have made wrong decisions in the past, PFIs are an example of poor procurement. Solution would be for government to tackle this issue head on by terminating these contracts. Not to make ends meet by compromising patient care and over stretching serviced. Finally, amazed that you think more tech could replace years of medical training and experience…Good luck with that one, clearly you don’t need experts.
    Good day.

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  13. I don’t think it was the GPs that stuffed the government with the deal offered by Labour. I read elsewhere (can’t find it now sadly) that the GPs could not believe their luck when the government proposed the contract that they did, they almost couldn’t sign fast enough or write in a steady hand for giggling.

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  14. In response to Grimbler: What a patronising comment! Clearly, you’re out of touch with the workings of the NHS and only want to believe a particular narrative espoused by certain anti-BMA quarters. If the NHS gets dismantled, i hope you have sufficient medical insurance!

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  15. I’m an American working in London, i’ve never been happier knowing that i can visit the GP whenever i need to without worrying if my insurance covers the treatment. I may not get the appointment straight away but i am seen, i’ve also used the Out of Hours Service, the doctor was just as good as the regular doc at the Surgery. I don’t understand you British people with 24 hour access throughout the year, i will miss this healthcare when my contract runs out.

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  16. Anastasia, the NHS crisis has been hotly debated at my workplace and a lot of us agree that we don’t pay enough into the system and we would willingly pay more. It takes just one serious illness or operation to wipe out the contributions we’ve made, a colleague was due a knee operation but the date didn’t suit, as he had a Stag Do to attend. He arrogantly declared he would opt for a private op but then winced at the cost of £13K just for the op without the add ons of after care. He’s only been working for 5 years, in no way did his NI amount to more than £13K nor could he afford to go private. He opted to miss the stag do and went for the op on the NHS!

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  17. I find the remarks made by Grimbler totally out of sorts! Don’t know any GP or Consultant that would refer a patient for an operation that is not necessary. If you did some research, you will find that there is a demand for female GPs and the suggestion that tech could replace the work of GPs and Nurses…you need a lobotomy mate! In fact, you sound like a troll!

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  18. Dear Anastasia I guess you are not a doctor or a senior manager so good try aside from the cost of ibuprofen /paracetamol 19/20p! I know several people who work in the health service and they all know that doctors are a major part of the problem from arrogant consultants who will carry out unnecessary operations to GPs who stuffed the gov with a pay deal which gave them a nice 9 to 5 existence for even more money and less obligation to their patients out of hours, to sex equality for doctors which resulted in 50% plus GPs being women who naturally have kids and as they are relatively highly rewarded see no need to go back to work full time, to the most powerful trade union the BMA which ensures there are never enough doctors being trained. Finally there really are too many managers in the NHS. I could add that modern tech would allow any bright person to do a Gps job with say the equivalent of a nurses training but of course not likely to be trialled GPs have a legal stranglehold on diagnosis!

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  19. “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.”

    Sorry I have to disagree that was possibly the most toe-curlingly embarrassing thing shown to a global audience in decades. What’s more as long as politicians adhere to the mantra of ‘our NHS’ to prove how much they care no real, effective change will ever be possible.

    You do highlight some issues though such as unnecessary prescriptions and procedures that aren’t truly essential healthcare, I fear too often the ‘mental health’ excuse is thrown around far too readily when it comes to cosmetic enhancements – although that is merely a feeling on my part.

    I’d be interested on your take on the need for nurses to have a degree. Has it improved things?

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