How do we ease the pressure on the NHS while protecting all that’s best about it?
The NHS was under the cosh long before the pandemic. Every winter, almost as regular as clockwork, you’ll see the news stories of waiting lists increasing and ward capacity stretched to breaking point by flu season. Add Covid and the resulting enormous backlog of elective surgery to the list and it’s clear that this is not a problem that can be solved quickly or cheaply in an institution that, irrespective of the money pumped into it by governments of every political persuasion, seems perpetually short of time, people and investment.
So is there another way?
The Australian nudge
Australia has a system largely similar to that of the UK’s (it’s called Medicare but it’s not to be confused with the US system). One of the biggest differences is how Australians pay for it. For most Australians, Medicare is funded by a 2% tax on income. That enables them to free healthcare across a range of services, although its fair to say that range is a little less generous than in the UK.
If you earn AUD$90,000 or more (at time of writing) you pay an additional 1% on top of the 2% levy. Earn AUD$105,000 or more and you’ll pay 1.5% extra. For Australia’s wealthiest, this quickly adds up to a more expensive way of funding healthcare than taking out private health insurance. So you have a system where most healthcare is free to most people, with the wealthiest nudged to take up private healthcare and penalised by the system if they don’t.
You may have an immediate reaction to this. You may point out that the NHS is regarded as the finest example of public healthcare in the world, and any attempt to ‘dilute’ that should be resisted. You’d be right that the NHS is revered, and not just in this country. A 2017 survey by the Commonwealth Fund ranked it at number one in the world. Interestingly, Australia’s Medicare system was second.
Public and private, together
You might also have an immediate reaction to what might feel like an incremental erosion of the NHS, fearing that a larger role for the private sector would be privatisation by stealth. That’s certainly the gist of much political argument in the UK. NHS is good. Private is bad.
Yet the reality for medical professionals is very different. Life simply isn’t that black and white. There’s already a huge amount of interdependence between the NHS and private sector in this country. Every day, NHS operations take place in private facilities – and it’s been that way for years. During the worst of the pandemic, the private sector played a huge role in supporting the NHS. If private healthcare in the UK disappeared tomorrow, the NHS simply wouldn’t be able to cope.
These are not two competing forces. They are complementary in so many ways and interdependent in so many others. That’s not a view you may hear very often given that the NHS is so often treated as an emotive political football, but it is the reality.
The issue is not ‘how do we erode more of the NHS’ role?’ but ‘how do we protect it?’. Since the NHS was launched in 1948 the number of doctors who work within it – to take just one measure – has increased from 11,700 to 115,000 as of 2018 (Source: BBC). Real terms (that is, adjusted for inflation) spending was £12.9 billion in 1948. Today it’s £150 billion, give or take. In 1948 the NHS accounted for just over 10% of all public spending. Today it accounts for three times that.
These are fearsome sums, yet for all the admiration the NHS elicits, no one could suggest it’s in a healthy place right now.
One way we could help address that is by having a grown up conversation about what we want the future of the NHS to look like. That conversation includes recognising that private is already a major part of the NHS world, and that nudging the wealthiest to pay for their own healthcare is not about establishing a two-tier system, but about ensuring there’s a free at the point of use health service fit for purpose for the very many people who will continue to need it.
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