The proposed NHS reforms still pose too many questions for many people. Dominic Howard analyses pressures within the health service that need to be taken seriously
EMBRACING CHANGE IN THE NHS
Reforms designed to reduce cost should also be welcomed, provided that quality is not sacrificed in doing so.
No one can deny that the NHS is a big beast that needs a lot of feeding and watering.
When the NHS was launched in 1948, it had a budget of £437m (the equivalent of £9bn now). In 1997, when Labour came to power, the budget was £35bn.
By the time they left office, it was about £110bn. Since 2010, the NHS workforce has grown in most areas by between 25% and 30%.
The average life expectancy in the UK rose from 71 in 1960 to more than 80 in 2009.
Demographic change is adding £1bn a year to NHS costs, according to health think tank The King’s Fund.
Healthcare for the elderly is funded through the taxes of a shrinking working population.
The expense is not sustainable, exacerbated by the fact that few people have any idea of the cost of their treatment and care in the NHS.
‘Free at the point of care’ is so deeply ingrained in the British psyche that no politician has the courage to stand up and suggest a fee, even though most other countries do this.
Top-ups have already caused controversy. Until recently, the NHS would deny anyone ‘mixing their drinks’, i.e. combining state-funded treatment with privately paid consultations.
Shouldn’t people facing long waiting lists for important surgery be entitled, if they have the means, to go private or at least contribute to overall costs to speed things up? Of course, the purchase of PMI that either pays for all medical services or dovetails with the NHS is not new.
Insurer WPA, for example, includes coverage for advanced cancer drugs that are not available on the NHS.
The NHS has been described as the best system in the world, but without any clear criteria. Just like the reforms themselves, words such as ‘best’ mean different things to different people: clean hospitals, short waiting times, à la carte menus in hospitals, private rooms with satellite TV many of the things that PMI can buy you.
But not all of these can be delivered within the means at everyone’s disposal.
However, the moment you start taking shortcuts in what really matters – namely clinical excellence and expertise and the focus is too much on profit, the only person that suffers is the patient.
Ultimately, when you do not treat a patient correctly first time, you can create complications that ultimately cost more.
We have conducted surveys in the USA and the Netherlands, reviewing hundreds of cases predominantly orthopaedic, neurological and oncological that show how significant savings can be generated for employers and insurers alike just by ensuring people get the correct diagnosis and treatment first time.
Savings and quality need not be mutually exclusive.
Expertise among consultants can be measured in a number of ways. Consultants can write research papers and gain a reputation for expertise in a sub-speciality of medicine.
But often the best qualifications are gained from practical experience, either consulting or operating.
One surgeon may work in a clinic or hospital that performs a particular type of procedure ten times a day, while another may work in a different clinic that performs the same procedure only once or twice a day.
Apart from cost efficiencies through economies of scale, the clinic handling more procedures can probably build up a bank of greater experience of benefit to the patient.
It is often stated that ‘medicine is not a business’ but an egalitarian right. However, like a massive monopoly, the NHS owns the staff and the buildings (the hospitals, and many GP surgeries), it provides all the finance as well as all the services, and it owns all the patients.
If it was a plc, what would the Financial Services Authority make of it?
We may never abandon respect for the NHS because many of its professionals are exceptional people, genuinely motivated by a desire to heal.
But something has to change in the system in which they operate. As to exactly what, you’ll probably get a better answer from a crystal ball.
Dominic Howard is director, UK and Europe at Best Doctors
