The NHS is in crisis. Even the government acknowledges this, although it will not admit it. There are problems with the way it is managed and the way it is structured. Ministers have tried to distance themselves from these problems behind a mountain of quangos. Yet even if all these failures and stupidities were dealt with, the key problem would remain. The NHS funding model is no longer fit for purpose. The nation is trying to do too much with too little when it comes to the nation’s health and social care. This cannot go on and a conversation has to begin to put things right. A lot more money is needed, at least a third more. Perhaps an even bigger increase, is required to bring our provision up to a modern standard, unstressed, effective and efficient.
The total cost of the NHS in the last financial year was about £116 billion. Of this £100 billion was spent on NHS England. Total revenues received by the Treasury from all sources were around £534 billion, so it is clear that a high proportion, roughly a fifth, is being spent on health. That is a lot, but it is nowhere near enough. There is a credibility gap, between the huge sums the government throws about in soundbites to evidence its generosity and the shortage of money everywhere apparent in the system itself. This is because we look at percentages of the revenue stream, when for health we should look, as other developed countries do, at percentages of GDP. By that measure we come at or near the bottom for expenditure, as well as for doctors per head of population and likewise for beds. So it is a bad report. Yet the NHS is our biggest employer, with more people working for it than anywhere else and its performance gets more air time than any other function of government.
So where does it go wrong?
First, as I have said many times before, you cannot provide an infinite service on a finite budget, any more than an airplane can fly without wings. The more patients who arrive at the various points of demand, the less money there is to go round and the more stretched resources become. We have to change to a system which increases the flow of cash the more patients, procedures and treatment the NHS actually provides on the front line. Each patient brings in money. More patients must mean more cash. The only way to do this is to alter the funding model to an insurance based platform.
This does not mean profits for medical insurance companies and exclusions for pre-existing conditions. It means the government (or its own insurance corporation) becomes the insurer and charges everyone a premium which reflects the cost of running the NHS as it happens and properly. The insurance is compulsory, covering everybody, thus eliminating underwriting issues about contra- selection. Everyone contributes and everyone is covered, no matter what their health situation. The cost varies year by year depending on the demands made upon it. On current figures it would more or less replace the basic rate of income tax, which could begin much higher up the income chain. Meanwhile premiums would be expressed as percentages of personal income, so that higher earners would pay more and the lowest incomes nothing.
The other reform which is a must is that all medical staff must be employed by the NHS and work exclusively for it. Self employed GPs under contract and Consultants seeing patients in private practice, culled from NHS waiting lists, is absurd and has to end.
These are just ideas. They are not new. Neither are they exclusive to this blog. You will begin to hear about them more and more. The time to fix the NHS has all but run out.
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