An all-new opinion battle where one divisive subject erupts, giving way to diametrically opposing views from two senior healthcare commentators.
Jane DeVille-Almond, Independent Nurse Consultant and journalist
Having worked in the NHS for almost two thirds of its existence, I love it and its values. Anyone who dedicates a life to the NHS is committed to Bevan’s principles – healthcare provision based on clinical need, not on ability to pay.
But healthcare is not free. Healthcare costs the NHS £116 billion per year and the money comes from us.
The NHS was developed at a time when children were still dying of polio, before kidney transplants, heart bypasses, breast screening and fertility treatment.
Who could have foreseen the change in UK demographics and the impact this would have?
For fear of losing popularity, no one in Government seems prepared to admit that the NHS is simply too expensive to run without making difficult changes.
Already we are seeing community services for the elderly stretched, mental health services almost non-existent in many areas, GPs so overwhelmed they are leaving and nurses so overworked that hospitals are unable to recruit them. The big fear is, if we refuse to look at other models, the NHS could fold completely.
The NHS loses millions every year. Partly because many have no respect for it, partly because people have little idea of the real costs, and partly because no one is in control.
For those who can afford it, we should charge a fee for visiting a GP. Where people can’t, then we subsidise, as they do in Jersey. Charge people for missed appointments, make sure people know the cost of medicine waste and encourage people to look after their own health. We need to stop living in the past and move forward with innovations brought by involvement with the private sector.
Dr Guy Pilkington, Assistant Chair of NHS Newcastle Gateshead Clinical Commissioning Group
The challenges facing healthcare systems across the world are as great now as they have ever been. Why should we stick to the founding principles of the NHS, when the pressures upon it grows inexorably? Let me explain.
The NHS is designed to be comprehensive and accessible to all regardless of ability to pay.
The welfare state was created as a universal service and remains one of the few foundations on which our sense of shared community is built. Margaret Thatcher was wrong, there is such a thing as society and the NHS remains the clearest articulation of that.
Remind yourself of these values and read the NHS Constitution when you get the chance. The most cost-effective way to fund a universal system is through general taxation. We have an ageing population, pressures grow year on year, so let us commit to the best way of doing that.
The NHS is far from perfect. I believe it has yet to invest in prevention, mental health and caring for the most marginalised at the levels required to tackle stark inequalities we see across the nation. Part of that requires us to stop over-medicalising many of the things we deal with on a daily basis – unhappiness, loneliness, the effects of poverty and traumatic events in childhood.
A privatised system is incapable of rising to these challenges, and will worsen the inequalities of access and outcome we have today, costing the nation far more.
Remember, the UK was judged as the top rated health service in the Commonwealth Fund think tank 2017 comparison, despite nearly 10 years of funding squeezes and a much lower proportion of GDP spend on healthcare than more privatised systems.
Mark Loughridge from M&F Health Communications
The ‘privatisation’ debate has always struck me as characteristic of the problem that has dogged meaningful discussion of NHS policy, and wider public policy to boot.
Put simply, the problem is one in which a complex series of questions are posed – ‘how can we manage the demographic pressures facing our health service? And, can the NHS keep up with revolutions in medical science? Or, is there still a role for local commissioning in an increasingly collaborative system?’
These questions normally receive a knee-jerk, one-dimensional answer.
It is much like the Bank of England looking to discuss how best to manage an uplift in the rate of CPI inflation, only to trigger a spirited debate about whether we should abolish currency altogether.
In a system as clear as mud, where formidable challenges seem to lurk behind every bedpan, privatisation is a soothing medicament for the overwhelmed. But it provides no real answers to the intricate problems facing the health service, instead offering a reheated brand of 80s economics when far more nuance is required.
Ultimately, an insurance-based system answers none of the questions, and offers no solution to perhaps the greatest problem it would inevitably create: extraordinary operational and political upheaval in an uncertain and febrile climate.
So, let’s ignore the false friend of privatisation and push for real reform in our health service. Let’s challenge ourselves to create innovative change, firmly rooted in the fundamental principle of an NHS free at the point of use.