It seems to be accepted that the NHS is horribly underfunded. Today, the Chief Executive has made a speech in which he's argued that the government should pump in huge additional resources right now, in anticipation of the supposed windfall that will arise when the UK leaves the European Union. Would this really be the right way to go ?
When the NHS was founded, it was expected that it would result in improved health for the nation and that costs would actually fall over time; that this was a foolish and hopelessly misguided expectation is now apparent to all. In fact, the notion of a national health service, paid out of taxation and free to all at the point of delivery is no longer plausible. Over the years, an assortment of charges have been introduced to cover optical, dental, prescription and other services but, at the same time, the range of services and treatments provided has expanded massively and to such an extent that ever increasing sums of money have to be found in order to keep the service solvent. Unless things change, the NHS and the associated Social Services, will expand to such an extent that they will absorb far more money than any government can supply without raising taxes to a degree that the population will find unacceptable.
New drugs and treatments, new equipment which allows for much better diagnostic services, a rapidly aging population and an expansion of services well beyond anything originally envisaged all combine to render a 'free for all' NHS no longer viable. The government could pour in billions of pounds more than it has in recent years and it would still not be enough; every year, senior NHS managers and clinicians would still demand more. How much would it really take to bring the NHS to a point at which these cash-hungry voices would be satisfied - £10bn, £20bn, £50bn ?
If we take the middle one of these figures, £20bn, which I suspect would be the least necessary to achieve what some say is needed, that would need income tax to be raised by a eighth, national insurance to be raised by a sixth or VAT also to be raised by a sixth. My, admittedly amateur, calculation suggest that this would equate to around £30 - £40 a month for an average earner; would people really be happy to see such increases in their taxes ? More of their hard earned wages being sucked into the government's ever-open coffers with no real guarantees that the money would actually bring about the service improvements that are needed.
No, I don't think they would. We already pay huge amounts into a vast black hole whose efficiency is questionable and whose profligacy is legendary. The NHS, in common with most nationalised services, is subjected to a ludicrous level of pointless and costly rules and regulations; it's required to
commit considerable resources to all manner of central reporting and is hugely bureaucratic by nature. What is needed is a total rethink.
The NHS in its present form is unsustainable. The original idea was fine but it's now grown into a something that couldn't even be imagined back in 1948 when it came into being; the only sensible way forward is a hybrid system, part state-funded and part insurance based. Emergency services and what flows from them should be funded by the state, as should preventative services such as vaccination and services for those who are unable to make their own arrangements. Services for the more common conditions and associated treatments, children's services and health education should also be free but much else should be moved to an insured basis; individuals should make their own arrangements based on the increasing availability of information that is available to them. One has to expect that, within a very few years, DNA analysis will be commonplace and people will be well aware of what conditions are likely to affect them and what are not. Aided by such information, people should be well able to arrange insurance that will cover them for any required treatments.
We have to stop thinking that the state can pay for whatever we need while forgetting that the state is actually us. Personal responsibility is the key and we all have to prioritise our spending; for those who prefer to have spend on cigarettes and beer, a new mobile 'phone', fancy holiday, or new car rather than providing for their health needs, tough. "You pays your money and you takes your chance" should be the mantra.
I don't pretend that changing the current system would be easy, in fact it would be very difficult as the political pressures and ingrained nature of the NHS would be hard to overcome, but it needs to be don. Sooner or later, it will have to be.
No comments:
Post a Comment