The NHS is the unofficial state religion of Britain. It is loved for being free at the point of use and is a symbol of Britishness. However whenever reform is suggested, there is uproar. Current reforms are being strongly opposed by the health profession’s most respected bodies, the BMA (British Medical Association) and the RCS (Royal College of Surgeons). Their opposition is enough to kill the reforms and make Andrew Lansley resign. The question to ask is why do they oppose reform so much?
I believe special interests are driving resistance. The BMA and NCS hate the thought of change. They prefer the familiar to the unknown and despise the thought of transition from the status quo to the new system. There is going to be discomfort, teething problems, and the need for retraining. They know how the system works and hope to preserve it.
Secondly, both associations wish to preserve their power as the dominant voice in healthcare. Primary Care Trusts will be abolished and replaced with groups of GPs (consortiums) that can contract out services to the private firms. These reforms threaten both associations’ power within the NHS as it becomes more difficult to use the bureaucracy to consolidate their control; coupled with decentralisation of decision-making, power is dispersed further away from their hands.
The next two decades are going to be difficult for the health service. From the outset of the nationalisation of healthcare, it was warned that costs would rise exponentially over time due to the availability of new technology, treatments and services over time. This has been the case, and after Labour took office in 1997, healthcare spending has grown massively. Health spending rose from three per cent to 4.8 per cent of GDP in Blair’s first term, and increased to a huge 7.4 per cent of GDP in his second term.
“Special interests are driving resistance. The BMA and RCA hate the thought of change”
The state is also at its maximum size and individuals are taxed to their eyeballs. The government’s total liabilities (promised spending) account to 392 per cent of GDP, and individuals are on average taxed 37 per cent of their incomes. We cannot raise taxes any further as it will crush entrepreneurialism. We simply cannot keep on spending money that we don’t have.
More worrying is the dramatic change we are seeing in our demographics. Currently 19 per cent of the population is over the age of 60 but based on recent projections, by 2025 25.5 per cent of the population will be. The demand for healthcare will rise and at the same time, the workforce is not being replaced with young individuals to pay the required tax to keep the older generation healthy.
This is why we need to push on with these first reforms and introduce the profit motive within healthcare. It is all well and good talking about the NHS ethic of not operating for profit, but people need to be realistic about the rising costs of healthcare, and changes in our demographics. It can’t exist in its current form, and that’s why it needs reforming.
The competitive private sector will raise standards and cut costs, as firms will be competing to make profit. It will become more flexible to the changing demands of the market and able to provide new technologies, treatments and services at lower costs. These reforms may lead us to a new direction of healthcare provision. Why can’t we have a privatised healthcare system that is backed by an Europeanised state insurance system? Or state-funded Health Savings Accounts? There is a plethora of ways to fund healthcare publicly whilst the system is not run directly by the government.
The BMA and RCS should be representing its patients and not its own interests; they are guilty of trying to preserve their own power. The government must press ahead in its agenda to keep spiralling healthcare costs under control, abolish needless bureaucracy and bring in the private sector to improve public health provision. Assuming that you want to have state funded healthcare in 20 years, support these reforms or see the NHS crumble.