10 April 2014 — OurNHS
The question of NHS ‘affordability’ is used by think tanks and politicians to browbeat us into accepting regressive changes that suit the few, not the many. Better options to save money are ignored.
The cost of healthcare is rising. We are living longer and technology, drugs, and skills are advancing. We currently spend £111bn (2013/14) on the NHS and we will need to spend considerably more in the future.
Funding the NHS is about choices not affordability. If we invested a similar proportion of our national wealth as Germany and France do (both around 11.5%) the NHS would have about £25billion more than it does now.
Affordability is the wrong question. The right question is what do we prioritise? We could invest in the NHS and make it the best healthcare service in the world. We could refuse to invest in High Speed Rail 2 or the Trident replacement.
Instead this month we have seen two proposals from ‘independent think-tanks’ about funding the NHS in the future. Both groups suggest we should all pay more through a range of additional fees.
Most worrying are the proposals by The Kings Fund. This organisation has a rich history and was formed in 1897 to help the poor access healthcare in London. This appears to be the last thing on its mind today.
Last week it published its Interim Report on the Future of Health and Social Care in England – 86 pages setting out what its ‘Independent Commission’ think must happen to save the NHS from becoming ‘unaffordable’ and ‘unsustainable’.
The author, Kate Barker CBE, a business economist, has suggested a range of ‘options’ to increase income for the NHS. By and large these mean those who use it having to pay more.
The Kings Fund’s ideas include:
- Over 60s (except those on pension credit) to pay for prescriptions – £1.5bn
- Increase the qualifying age to 65 – £value unknown
- Raise the prescription charge to £10 – £100m.
- Or remove all prescription exemptions and charge £2.45 to all – £2bn
- Charge to visit the GP from £5-25 – £3 billion
- Charging to attend A&E £10 – £220 million
- Charge £10 for outpatient attendance – £800m
- Charge £10 for each day in hospital – £500m
- Charge £50 for each hospital ‘procedure’ – £900m
These suggestions are really bad news for those over 60 and anyone who has any condition that may require frequent visits to their GP, other NHS service or prescription medication.
Is the NHS really so ‘unaffordable’? By international standards, NHS expenditure per person is about average. After years of underinvestment, we now spend 9.3% of our country’s annual wealth (GDP) on healthcare, which is about average for the 34 OECD countries.
Removing the NHS ‘market’ would save at least £5 billion according to FullFact.org.
The Kings Fund itself admitted that abolishing the market system had cut costs and improved productivity in its report on a New Zealand health system.
The Kings Fund prides itself on being independent and free from political interference. So why did its report into the UK not propose increasing public expenditure on health?
And why did it not propose reducing costs by stopping the waste associated with the NHS ‘market’?
One reason might be that the Department of Health has paid the Kings Fund over £511,000 since 2010. The Kings Fund Chief Executive was previously an advisor to the Department of Health which I’m sure helped secure the income but didn’t do anything to promote independence.
In the same week as The Kings Fund report, came a report from fellow think tank Reform. This report is authored by Lord Warner, a former Labour health minister. It wants us to pay £10 each time we see our GP and £20 a night for a stay in hospital.
Reform is backed by 64 private sector companies. There is clearly a need for think tanks producing evidenced based analysis but Reform behaves more like a lobby group hiding behind the pretence they are doing independent work when in fact they have an agenda for profiting from the NHS.
Healthcare and profit are a bad combination. Ask any of the 47 million non-elderly Americans that were uninsured in 2012.
Lord Warner said the NHS is “often poor value for money”. People who know me will know I’m not afraid to criticise the NHS when the facts support that criticism. Lord Warner doesn’t provide any facts that the NHS is poor value because the evidence is the NHS is good value.
During the public consultation for the Health & Social Care Act, ‘Reform’ lobbied extensively alongside the NHS Confederation to ensure the Health and Social Care Act pushed wide open the door of privatisation. This might surprise NHS hospitals and NHS Trusts, who believed the NHS Confederation represented them not the private sector. There is no mention of lobbying for profit or the private sector at all on the NHS Confederation website.
If I were now an NHS Trust Chief Executive, I would have already cancelled my subscription.
Before we accept the wisdom of ‘think-tanks’ they need to come clean about who funds them. Reform and the NHS Confederation are promoting a private sector agenda backed by private funders. Reform are also directly linked to the Prime Minister who appointed Nick Seddon as his health advisor. The Kings Fund is not addressing the most obvious cost in the NHS, the internal market, because it would be biting the Department of Health hand that feeds it.
What they all seem to have forgotten is that through income tax, VAT and duty on such luxuries as beer and bingo we are already paid up members of our NHS.
About the author
Gary Walker is a former NHS Trust Chief Executive Officer.
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