Privatisation of the NHS

With the current affairs section of the interview, it is likely you will get at least one question on the privatisation of the NHS. When answering these questions, its important you acknowledge the benefits while stating how it fundamentally contradicts the founding values of the NHS, the NHS constitution, and the GMP.

NHS England

The NHS is estimated to need an extra £30bn. Currently, it has secured a 3.4% increase in funding each year (~£6 billion) until 2024 under the 2019 NHS Long Term Plan. However, this will not be enough, and The Health Foundation states this needs to be increased to 4% to keep up with rising costs and improve services.

Privatising Healthcare

There has been two suggested ways for increasing the funds of the NHS:

1. A two tiered healthcare system - people who can afford healthcare, will pay for it (or make a contribution towards it) - one tier. Whereas, those who can’t afford to pay for healthcare will still be able to access it for free - the other tier.

Advantages

  • The NHS requires more money with the ageing and increasing population. Furthermore, equipment costs and the cost of living is rising.

  • Increasing staff pay may encourage more staff and increase satisfaction. Less staff dropout and burnout.

  • A better funded NHS will “improve [the] lives” of the patient as prioritised in the NHS Constitution.

  • This is not new. In the 1950s when budgets were tight, charges were brought in for dentistry, optometry, and prescriptions (with the prescription fee being kept in England).

  • A two tiered healthcare system will mean people who can’t afford it, will still access free healthcare.

  • 20% of healthcare in England is already private. Many people would not mind paying an extra charge if it improves healthcare for all.

Disadvantages

  • Contradicts the founding principles of the NHS: “Free at the point of delivery” and “based on clinical need not an individual’s ability to pay”.

  • Contradicts the values of the NHS in the NHS Constitution: “Everyone is equal” and “Working together for patients”.

  • Money may not solve the complex issues facing the NHS. The focus should be on staff shortages, wellbeing and social care.

  • By having a two tiered system, this could create friction between people in the different tiers and also biases from NHS staff when treating patients.

2. Charges such as a ‘missed appointments charge’ or a ‘bed and board charge’.

Advantages

  • The NHS requires more money with the ageing and increasing population. Furthermore, equipment costs and the cost of living is rising. Charges may supplement some costs.

  • A charge will deter patients from missing their appointments. Currently, 15 million GP appointments are missed each year.

Disadvantages

  • Charges will affect people disproportionately: richer people can book many appointments with no fear of the charge, whereas poorer patients may suffer if they miss an appointment due to unforeseen circumstances.

  • Charges might encourage poorer people to prioritise money over healthcare.

  • Doctors may be inclined to treat the paying patients first.

Although the NHS requires increased funding, this should not be done through privatisation or charges as this directly contradicts the NHS founding principles. Instead, a redistribution of national funding or increased taxation for richer people should be implemented.

NHS Scotland

NHS Scotland recently proposed a two tier healthcare system and methods to reduce costs alongside the proposed National Care System (NCS). This includes:

  • Wealthy people having to pay for some/all of their treatment.

  • Reviewing treatments that don’t offer many QALYS and reducing their funding.

  • Pause funding for new drug development unless they are expected to save the NHS money.

  • Stopping care services all together under the NHS and instead incorporating them under the NCS.

  • Considering a charge for ‘freedom of information’ requests.

Issues facing NHS Scotland

These changes were proposed after Scottish healthcare has declined:

  • Scotland records some of its worst ever A&E waiting times. 4x more people are waiting over the four hour standard than in 2013.

  • A shortage of GPs is leading to prolonged GP waiting times.

  • Over six thousand nurse and midwifery jobs are unfilled.

  • Life expectancy has plateaued since 2012 and actually decreased in poorer areas.

  • Health inequalities of Scotland are the worst in Western Europe.

  • Between the poorest and richest regions of Scotland:

    • The gap in Life Expectancy is 13 years.

    • The gap in Healthy Life Expectancy is 24 years.

    • Drug related deaths are 17x more common in poorer areas.

National Care Service (NCS)

This is a proposition for a nationalised care system for Scotland. A ‘NHS for Care’ which will:

  • Manage care on a national level. Care in an area will be controlled under Regional Care Boards which are controlled by Scottish ministers.

  • Create a ‘Charter of Rights and Responsibilities’ of social care and a ‘Complaints and Redress’ process to standardise and improve care.

  • Provide a free-at-the-point-of-need system. However, patients will have to pay for the accommodation costs. This means social workers, care at home services, therapy etc. are free but a patient will have to pay for the accommodation fee for a care home/if they have to stay from home.

The Importance of Social Care

By improving social care, this also improves healthcare. This can be described in 3 steps:

  1. Increasing funding for care decreases exit block.

    Over 50% of patients who are well enough to leave the hospital, do not. This is due to a lack of social care (e.g care homes and care at home services). Therefore, there are less beds to accept emergency patients which increases waiting times.

  2. More beds being made available will decrease ambulance waiting times.

    Ambulances are unable to leave the hospital until a bed is free. Exit block is preventing patients in a critical condition receiving the care they need.

  3. People are seen faster decreasing deaths and chronic illness. Prognoses are improved.

    Shorter waiting times also means that patients are more inclined to go to A&E about their maladies. This will improve their prognosis by enabling the doctor to treat the acute phase of the illness before it enters its chronic phase. Shorter ambulance waiting times will also save lives.

Should we fund the NCS?

Advantages

  • It will decrease A&E and ambulance waiting times, improving healthcare and saving lives.

  • “Improves lives”, “Working together for the patient” and “Equal care” - it follows the values of the NHS Constitution.

  • Enables the NHS to focus on delivering healthcare and the NCS on delivering social care.

Disadvantages

  • It is expected to cost £800m. There are concerns about how it will be funded (e.g increased taxes, or resources diverted way from the NHS) considering the NHS is already underfunded.

  • Councils will no longer control the delivery of social care. It will, therefore, reduce the power of the local democracy.

  • By dividing healthcare and care into two organisations, this may delay and complicate the transferal of information.