In my line of policy posts, (this is the second, so officially a line) I want to explore the future of the NHS. I am the first to say that this is a hugely complex problem but I think taking some time to determine what we want out of a Health Service that serves everyone. This post covers only a few of the points that needs to be addressed but fundamentally suggests that we need to develop a new Health and Social care model, and launches the idea of the UHC, – Universal Health Care, resetting what it means to be looked at in the contemporary setting. I will warn you that this isn’t a well structured piece, but an exercise that is helping form my thinking about the future of our systems. This is the type of process that is done behind closed doors and then presented to the world, but I’m encouraging you along for the journey, to contribute and help shape this policy. However, if you think that healthcare should be privatised and that you don;t believe in paying tax for national services, for the good of your blood pressure, stop now.
The underpinning question is what do we expect of a national health service, because our current system is not a complete health service, we have spun off different bits already, such as optical and dentistry, physiotherapy is somewhat hit and miss and that is before you look at the privatisation of GP provision, and then you step into the murky world of social care.
Fundamentally the NHS is a fantastic idea that strikes at the centre of what it means to be a caring individual and looking after each other. I would class this quite simply as “giving a toss” about fellow people, even those you don’t know. Whilst it was a Labour government that brought it in, it has been largely sustained through different flavours of government and it could be argues that the different governments have given a “positive tension” that has flexed the NHS to deal with the evolving issues.
But, fundamentally I think we need to go back to basics. What so we want the NHS to do. With my most naive hat on, I would like to see an end to end health care systems that is free at all points of use. So no matter if you’re getting a filling, some physiotherapy, major heart surgery, or having a carer coming to help you recover and live, then I think the state is best placed to be the most cost-effective way of looking after you. But with my more sensible hat on, then we know that universal healthcare is expensive, it needs paid for. So this means two things, firstly you need taxation to pay for it, and secondly you need to bound what is available. It is this bounding action that firstly influences the taxation element, but also causes the most heartache when treatments and medications fall outside of the boundary.
So, I think we need some tests and definitions to determine what, and who, should be inside and outside of NHS care.
Firstly, who should be covered? UK Tax payers, obviously, they are paying for the system. But not all residents pay tax for a variety of reasons, they are under 16, they don’t earn above the tax threshold etc, so let’s be simple and say all UK residents. That passes the “giving a toss” test. So, to go further, what about visitors, people from other countries? They don’t pay and wouldn’t pay into our tax system, so it is suitable that they should pay for the use of the services. Now, this fails the “giving a toss” test, because in an ideal world we would help anyone and everyone, but I guess this is where the real world test comes in. I think if we could aim for reciprocal arrangements with countries to provide healthcare, then that would be good, but until we get to the stage of worldwide free healthcare, then we have to draw the boundaries at our national boundaries.
What and How?
Now the what, firstly look along the healthcare “timeline” which covers the variety of services, I wold like to see them all be free at the point of use, including dentistry, major surgery and social care, all under the banner of the UHC – Universal Health Care (I just made that up, other names are available). In essence, all “stages” of treatment, from initial diagnosis through to recovery and end of life care to be covered under taxation. This MUST include mental health service, preventative advice and engagement, therapeutic care and social care (including in the community). The current “spending pots” would be analysed and brought under this one organisations control to deploy effectively. Though that could also include commissioning services where appropriate, there would have to be an “in-house” bid developed if a tendering process is undertaken. Fundamentally we break down the barriers between the NHS and the social care system, they are so symbiotic that we need to properly bring them together. But potential boundaries could be cosmetic surgery, reviewing fertility treatments, and also not killing off the private sector, if people want to go to a private medical clinic, then that would be fine, but that clinic is self funding and must achieve the same standards.
But, the other issue with providing healthcare is that as science advances, we are getting more and more people who can be cured, or treated, but the individual costs are rising for more complex drugs, and that costs money, so decisions have to be made about providing a few people very complex treatments, or more people cheaper treatments. This problem is not going to go away, and its only going to get worse, so those decisions will have to continue to be made on a case by case basis. However, we do need to seriously look at the profit margins being made by the providers of medical treatments (and supplies). There is an argument that the cost of drugs are so high because the amount of money the pharmaceutical companies plough back into R&D for the next line of drugs, and that a large percentage of develop drugs will presumably fail on the development path. But, if the government looked to fund the research itself, as it does in other areas, then the government would own an element of the intellectual property, but enable the companies to produce and sell the results. This would help drive our medical research industry and be less dependent on imports, any perhaps drive an export market too.
We also suffer from the fact that there are multiple companies and organisations all trying to do the right thing but also potentially at cross-purposes. This is why I would bring it all back in-house (under my new UHC organisation) where it can properly utilise spending power, remove postcode lotteries and share best practice. But the tough bit would be ensuring that it doesn’t “bloat” or invest massive layers of management. This can be done through and should be encouraged.
So, in this initial review, I have the main idea of a new health system, called Universal Health Care that provides a comprehensive health care, free at the point of use that brings under its wing all of it. Taxation would need reviewed to cover it and clear boundaries developed for both treatment and users. There is more in-depth work to be done to develop this properly, but as a bedrock principle, I think its time we went back to the roots and aim to “give a toss” again.
Over to you, how would you develop it, add to it, or throw some rocks at it.