Our health service is not performing well at all. Not only was there a failure to prepare for a pandemic but when it arrived there were shortages of personal protective equipment, patients sent untested to care homes and non-Covid patients refused care.
The NHS’ assurance that people will be treated free of charge when they need healthcare, regardless of their financial status is sacred in the UK. But the priority given to those afflicted by Covid has left those in need of other treatments unable to access care. In other words, the guarantee was broken.
There are a record 5.7 million people waiting for hospital treatment in England. One-in-four attendees at A&E are not seen within the four hour target. It might be years before NHS patients can have the treatments they need in an acceptable time frame.
The waiting lists arise from the NHS’s long suffering problem of central management. The attempt to direct from the centre all of the individual actions needed at the periphery almost necessarily implies a delay as information is collected and processed before instructions can be given to act upon it.
More recently, the funding model within the NHS has been the target of citicism. Instead of allocating money on the basis of procedures performed, block funding goes to trusts, and self-employed GPs are paid according to the number of patients registered rather than on how many people actually visit them for treatment.
But the NHS and the core principles it embodies can be saved. The first step should be making the NHS treatment guarantee explicit by issuing everyone with an NHS guarantee card. The card would guarantee treatment at any GP, specialist or hospital. The rates which the government would cover with that card for different treatments would be determined and reviewed regularly.
The second step would be to fund GPs, specialist consultants and hospitals according to the number and type of procedures performed. Hospitals, like GPs, would acquire independence, free to specialise in particular areas, and be funded by the government on the basis of treatments given and procedures carried out.
This model takes its inspiration from the Australian healthcare system, which has better health outcomes than the NHS achieves, and which is hugely popular. Australian’s universal government health insurance corresponds to the proposed NHS guarantee card, while their hospitals and doctors are a mixture of state-run and independent, paid by the government for each procedure they perform for patients. Patients can seek treatment from any qualified institution, and be covered by their government insurance, and in certain cases, an additional agreed fee for each piece of work.
This gives patients a choice. Crucially, it encourages both doctors and hospitals to seek more patient-friendly and more efficient ways of working. The inspiration we can take from the Australian system is the encouragement, though tax breaks, to take additional private insurance on top of the universal state insurance. A majority of Australians have some kind of private health insurance cover.
In the UK patients who seek private treatment are treated as valued customers because they provide the funding that pays the private sector salaries. By contrast, this relationship is absent from the NHS because there the link between treatments and funding is much weaker or absent altogether. We should endow NHS patients with the same status as their private sector counterparts.
The pandemic has exposed the weaknesses in the structure of the NHS. It can also provide the impetus to tweak them in ways that improve it. Modest changes could ultimately save it from collapse.