Edmund Stubbs: The choice to pay for a ‘turbocharged’ NHS

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“IN no way can we have anything like the NHS we have now if we are running such a huge deficit every year.” So argued Frank Field, the former Labour Minister for welfare reform, in April last year. Practically every researcher, health worker and hospital manager would surely nod in agreement.

They would also agree with Field’s subsequent insistence that “we have to think about the second phase of the life of the NHS. It has to be reborn”. A predicted £30bn funding gap by 2020 presents a looming problem for British healthcare. It threatens the existence, in its current form, of the health system that so many of us in the UK cherish.

Nevertheless, an equally terrifying prospect for NHS staff is that of yet another large top-down reorganisation. Many such reorganisations have been attempted over the past few decades, of questionable benefit. Consequently, Gwyn Bevan, professor of policy analysis at the LSE, describes NHS staff as “dancing on a moving carpet whilst trying to care for patients”.

In short, we have a huge funding problem: the very existence of the NHS is perhaps threatened by it, and radical action needs to be taken. However, another system-wide reorganisation seems likely to do more harm than good.

Our ageing population and increasing rates of chronic disease mean that the funding problem facing us is getting more and more serious as demand increases.

When a car cannot climb a hill, a turbocharger can be used to increase the car’s engine’s efficiency and power. A similar turbocharger is now needed to enable the NHS to keep pace with demand. Completely redesigning the engine is not a viable option.

Civitas’s new report proposes a scheme called the NHS Contribute Extra. This is essentially a voluntary contribution to the NHS of 0.5 per cent of annual income. By covering the associated administration costs, this voluntary fee would enable users to seek treatment from any NHS provider, ending the present postcode lottery where differing quality of care and approved treatments are available in specific regions. Additionally, it would help ease the bottle-necking experienced by certain over-demanded local services. Contributors would also have the option of taking their NHS treatment budget to non-NHS providers.

Civitas calculates that annual revenue from such voluntary contributions could easily amount to £3.5bn. Despite a proportion of this money being used to cover administration fees, most would be reinvested in NHS services. Where many patients are choosing to transfer their care from a given provider, it might be concluded that this provider is sub-standard. Consequently, it would then receive some of the extra revenue raised from the contribution fee in order to improve under supervision.

To try and tackle the growing national problem of lifestyle diseases, those caused by excessive eating, smoking, drinking and inactivity, the scheme would provide health-enhancing extras. Contributors would receive an annual health MoT where basic clinical measurements would be taken and health improvement targets set for the year ahead. Contributors would also receive discounts for activities such as gym membership, the aim being to shift healthcare emphasis to prevention.

It is hoped that individuals would consequently become more engaged in maintaining their personal health.

The principle of paying more for the NHS has significant support, with 50 to 60 per cent of the public in a range of surveys supporting increased taxation – but only if it is earmarked exclusively for healthcare. The NHS Contribute Extra would in fact be returning the NHS to its ideals as outlined by William Beveridge at its foundation, those of co-operation between the state and individuals to provide a secure level of free-at-delivery healthcare for all, while allowing people to build upon this substantial base.

The present postcode lottery leaves patients powerless when local services are known to be of poor quality. The proposed scheme would remedy this situation and generate much needed revenue. Less pressure on providers would give healthcare staff more time to train, forward plan and work in a careful, efficient manner.

The NHS Contribute Extra could help the NHS rise to its most formidable challenge, of closing the funding gap within five years.

The full report can be found at www.civitas.org.uk/pdf/NHSContributeExtra.