The political parties have two strands of consensus which at first blush may seem somewhat irreconcilable: a NHS which is universal, and free-at-the-point-of-need, and £15-20 ‘efficiency savings’ within the next few years.
Taxes could rise to increase the size of the public expenditure pot. thereby generating additional funds to flow into public funding for healthcare. There does not seem to be any political appetite for this approach at the moment. While technically possible (tax levels are far higher in Nordic countries than in the UK), this is unlikely to provide an answer in the short term.
The NHS is heading for a “breakdown” if people expect it carry on providing all services for free under increasing demand, the former head of Marie Curie Cancer Care has warned.
Sir Thomas Hughes-Hallett urged us to ‘take more responsibility’, encouraging us to think about what we ‘really need for free'; he gave his view of how to keep the NHS on the road, saying it should – like a a garage – charge “for extras”.
He said people “need a sat-nav” to point them what is “most convenient”, towards chemists or community support centres and “steer them away from the NHS when they don’t need it”.
He further added that people should treat their bodies like a car, with a regular MOT, and that “we need to take more responsibility for our own health”.
Hughes-Hallett, a trustee of the King’s Fund, and Executive Chair of the Institute of Global Health Innovation at Imperial College, London, predicted: “We need to make tough choices for now about what we really need for free”.
Unfortunately, Sir Thomas was a guest on Wednesday’s Daily Politics today, and his defence of his own argument was worse than pitiful as you can see here (at 1 hr 29 minutes).
car crash
Andrew Neil started the discussion by enquiring off Hughes-Hallett where he “would draw the line”, mooting gastric banding, acupuncture, and varicose veins.
For fertility treatment, he said: “there is no yes or no answer.”
Neil then replied that some difficult questions would have to be answered.
Alan Duncan MP said: “It’s free-at-the-point of need and that’s not going to change…. but for the mainstream medical needs, that’s not going to change.”
Vernon Coaker MP said: “This is the thin-end-of-the-wedge. The whole point of the NHS is that’s free-at-the-point-of-use, and if you start charging, you’re going to end up with a two tier service, and the poor will be disadvantaged.”
Hughes-Hallett claimed: “Many people are willing to pay.”
The NHS could start to draw in funds from other sources, such as co-payments and supplementary insurance. Again, these could potentially start to challenge existing views on equity, because they inevitably introduce an element of some kind of payment to access services. Exemptions and subsidies can mitigate this to some extent, but the more they are used, the more they offset the expenditure benefits of alternative sources of funding in the first place.
In a recent view, the departing CEO of NHS England said that the introduction of co-payments, imminently, was “unlikely”.
A question still remains over how to deal with services that fall outside the defined core package. If they are significant in the eyes of patients, markets will develop to cover those services, funded either through fee for service or insurance-based mechanisms.
On the one hand, the development of such a market might be regarded as undermining equity (some in society will be able to pay to access health services that are not freely available to all). Others will interpret it as a natural market response that is neither desirable nor sensible to prevent — what matters is ensuring that the core package of services that is available to all is adequate.
It cannot be denied, however, that a growing number of people feel that the marketisation of the NHS has gone far too far.
In fact, many want the market abolished altogether now.
