I’m a doctor, and here’s a 9-step plan to solve the NHS crisis – Dr Gautam Das
The headlines are back – screaming that the NHS is “on the brink”, “on a cliff edge”, “on its knees”. Operations are being cancelled, targets have not been met, waiting times are increasing. As usual, politicians argue that more money is being invested, while the department of health is wheeling out the same meaningless statistics.
There are, I believe, nine simple strategies which would make a large difference:
- The purpose of the NHS needs to be redefined so that it is fit for purpose in 2018. It should focus on being an institution for treating sick people and sending them home when they are ready. It should stop being a social guardian and avoid moral policing
- The captain of the ship must change immediately. In my view, the current person in charge does not have a vision or leadership qualities, has made no meaningful policies or change since 2010 and has instead contributed to the demonization of doctors and alienation of the workforce
- Politicians and media managers should be banned from spinning ill-conceived and poorly researched health-related statistics to further their own agendas. The concept of a target-driven service should be completely abolished
- Red tape and layers of management should be stripped back. For safe and effective delivery of services, every decision-making body should have clinical representatives who are always in a better position to understand NHS-related issues
- The NHS workforce should be valued, respected and appropriately paid so that they can work with more enthusiasm and compassion
- Resources should be streamlined for greater spending on increasing numbers of home-grown doctors, nurses and other health care professionals so that we are less reliant on doctors and health professionals from abroad and locum agencies
- The public should try to look after their elderly relatives in their own homes so that the dependence and burden on the social care system can be minimised. This will help to free up acute hospital beds which are often blocked by patients waiting for social care long after they have been declared medically fit for discharge
- Society should take more responsibility for their health, preventing hospital admissions for lifestyle-related illness. I would include excess smoking, obesity and a sedentary lifestyle in this category
- The public should pay to use parts of the NHS. Health care should be subsidised by the Government on all fronts and the public should also be asked to make a nominal contribution when they visit their GP surgery or go to A&E, so that the money can be reinvested in the NHS – the same theory that the Government says applies to hiking rail fares every year
MIMH
Here is the key sentence in the whole article
“the population has expanded and demographics have changed”
I’ve checked and the current birth rate in the UK is 1.8, below the 2.4 needed to maintain a stable population let alone lead to an increase. So it is clear that two things are leading to a crisis in the NHS
1. Increased immigration over the last 15 years
2. Increase in the age of the UK population in general
Therefore to solve this problem, you either need to greatly increase the tax rate or look to stabilise the population. Even stabilising the population will not help with the increase in average age of Brits, health care costs will continue to increase
For no.1 I do not know why we shy away from the debate, in 2016 the UK had a net migration of 500K, so if that continues then that is an extra 5 million in 10 years. By the nature of immigration they will not have paid any taxes before they came, so they will only start to fund the system once they pay tax. For those that are middle-aged or elderly then the tax burden to support them will fall on the younger generation.
JockM
I’m a doctor too. But not all medical professionals have all the answers, that includes me. To me, the first and most obvious issue to be considered; what is the basic level of funding, as a percentage of the country’s GDP, that should be provided? What is politically possible? The figure for the UK is open to debate, but is generally considered about 8.5% ( comparison here for instance: https://www.kingsfund.org.uk/blog/2016/01/how-does-nhs-spending-compare-health-spending-internationally ) and is one of the lower percentages in the EU. But do UK citizens expect to pay higher taxes to fund this, or omit their foreign holidays or other non-vital expenditure? Are governments going to raise income tax on high earners and collect due tax from multinational corporations? For the next 30 years or so, there is a cohort of baby boomers who are now reaching old age, infirmity and need and this is going to be expensive. We have to see how the money and wealth that many baby boomers have accumulated can be used to look after this cohort humanely, until they die. (I am 71, part of this cohort, but still in medical practice and more than paying my way) So we need to look at inheritance and gift tax in addition. Once the UK has seen the back of this cohort by 2050 at the latest, the country might be able to take a bit of a breather.
The NHS is probably one of the few things that makes life in the UK tolerable at all for many lower income families, living in poor neighbourhoods and lacking social support. Somewhere, sometime, some way, the citizenry of the UK is actually going to have to get it’s intellectual and ethical hands dirty and start to have a serious debate about what is important and worthwhile about being a citizen of the UK, and the simplistic and destructive party politicking that so much gets in the way must go. I believe any charge for primary or secondary health will be counter-productive – far too many poor people won’t be able to afford it and there will be so many exemptions, subsidies etc and the cost of collecting the money so intrusive and inefficient, don’t bother, there is no national virtue in requiring payment as some sort of penance for receiving medical attention. There are a lot of greedy unscrupulous people itching to get their fingers on the “more profitable” parts of medical care, many allied to or part of the Tory party; they should be denied any opportunity to do so.
The second obvious point is not medical at all, but what effort is society and its government going to make to keep the citizenry healthy? Good housing and insulation and sturdy self-reliant communities perhaps expanding allotment schemes and allowing some families to make a bit of money by providing produce at low cost to local communities, bypassing the big supermarkets etc, family planning, good diet with affordable health food options, affordable heating, less alcohol and continue reducing smoking, a living wage etc. – eliminating as much as possible relative poverty and the huge expenses of diseases and mental and physical ill health and below par existence that such poverty brings.
What happens to the UK economy is important of course, but the basic principles of the NHS can be accommodated in any economy, as it was after the Second World War, a time of rationing and severe economic hardship for this country. A fair health system is actually more important in a poorer country than a rich one.
Sorry, too long a posting, there are lots of details I could go into, but the ethical debate must precede all other considerations.
GW: It’s not fair to ask all of those who have paid 40 years’ tax – with quite a few sacrifices along the way – to then turn round in their post retirement years & fund – yet again – a group who have come here and are not contributing the equivalent. We contractually paid NI and so we are entitled to get what we paid for! Furthermore we probably subsidised, throughout our working life – on one hand the super rich – & on the other hand, the ones who were unable, for one reason or another, to work & pay tax themselves. Enough!
ukgovernmentwatch 