Time to change the NHS or risk losing it all

Healthcare costs have been rising unsustainably and now that change is proposed, the organisations representing patients are preventing the solution

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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.

5 comments

  1. “The BMA and NCS hate the thought of change.”

    Maybe they’re just tired of it? There have been innumerable, smaller changes, to the NHS over the previous decades. Here’s an article from 2005 on redisorganization theories in healthcare:
    http://jrsm.rsmjournals.com/content/98/12/563.full

    “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.”

    And a good thing too. Funding for the NHS was previously far too low. We’re now spending a similar amount to Norway, Sweden, New Zealand, Belgium and Canada:
    http://www.oecd.org/dataoecd/46/4/38980557.pdf

    And the NHS is apparently one of the most cost-efficient health-care providers there is:
    http://image.guardian.co.uk/sys-files/Guardian/documents/2011/08/07/JRSMpaperPritWall.pdf

    “Why can’t we have a privatised healthcare system that is backed by an Europeanised state insurance system”

    Well, Andrew Lansley stated yesterday that the ‘The NHS is not for sale, there will be no privatisation’, so either you or he isn’t sure what they are talking about in the context of these reforms (or perhaps one of you is lying)
    http://www.bbc.co.uk/news/uk-17093082

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  2. Also:
    “We cannot raise taxes any further as it will crush entrepreneurialism.”

    A land value or mansion tax seems unlikely to crush entrepreneurialism. In fact it might increase it, because it would mean people couldn’t simply inherit wealthy estates: they would actually have to work to survive.

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  3. Well, I’ve got a few points to raise.

    The BMA represents Doctors and has nothing to do with patients directly. This is a pretty basic point that you should know before slating them.

    I don’t know why you have only mentioned the BMA and RCS specifically and not the Royal College of Nursing (against the bill), the RCGP (against the bill), the RC of Psychiatrists etc. etc. who are all against it. Even the Faculty of Public Health, who you’d reckon would know roughly what will happen with the NHS after the reforms and have public health at the heart of their decision (not losing their power base) are against the bill.

    The RCS are only 1 of several colleges, and are no more powerful than say the RCGP, who probably have the most to gain from these reforms, and are 100% against them. The GPs will be in charge of the purse strings, and they don’t want to see this bill pass.

    This is a terrible article, pretty biased and ignorant of the basic knowledge needed to talk about the issues (the BMA represent patients?!?).

    I could go into more detail, but I need to go and do some work for my Medical finals. Good day.

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  4. First of all, the BMA and RCS are not patient groups, they are the trade union of doctors and a professional body for surgeons respectively. As such, they have no reason to answer to or represent patients at all.

    We do in a sense have a ‘Europeanised system backed by insurance’ – surely this is what NI contributions are for. People who can pay for private healthcare often do, and many who can’t afford it on their own have work related healthcare packages. This removes financial strain from the NHS in many instances, freeing up public money.

    Technologies and treatments are not developed by the provider but by separate manufacturers, and there is already a competitive market here. Price is dictated by the patents on said treatment and the cost of developing it. Needless to say a patented product is under exclusive licence to its developer and so there is a price monopoly until that patent expires irrespective of the healthcare provider.

    Privatisation is a dangerous road to go down, one only has to look at the US healthcare system to see that. Giving healthcare institutions carte blanche to make money from patients would be disastrous. As it is, medications are prescribed because a patient really needs it. Throw in a financial incentive, and a patient who doesn’t really need drugs to get through their illness becomes a cash cow; prescribed medication that will do them no harm, but equally will not really help and will simply make the prescriber a lot of money.

    Imagine picking up the phone, dialling 999 for an ambulance because your dad is having a heart attack and rather than being asked your address, you’re greeted with the question “do you have a credit card to hand?” Call me old fashioned, but I like the NHS the way it is.

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  5. This piece certainly does read as though it’s come straight from the coalitions spin room. Matt Sharp has eloquently tackled many of the points I find most contentious, bar one.

    “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.”

    I would certainly prefer a group of special interest individuals such as those in these unions, Doctors, Surgeons and Nurses of which many in our society owe a great deal. Opposed to those currently funding this bills steamroller approach through parliament (http://eoin-clarke.blogspot.com/2012/02/333-donations-from-private-healthcare.html http://eoin-clarke.blogspot.com/2012/02/author-of-this-piece-wishes-to-remain.html http://socialinvestigations.blogspot.com/2012/02/nhs-privatisation-compilation-of.html and even the special interests in the lib dems http://eoin-clarke.blogspot.com/2012/02/c1million-pounds-of-private-health-care.html)

    I know which special interest groups have the best interests of the NHS at heart.

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