The issues facing our health service are agreed by all of the political parties. We have an ever-growing elderly population with chronic and complex needs, changes in technology have allowed treatments never imagined 30 years ago but come at a high price, and there is an ever-increasing public demand for high quality and efficient delivery of services, preferably on people’s doorsteps.
Recent opinion polls put the NHS as the main concern of voters in the lead-up to the election, relegating the economy to second place.
What it boils down to is that people value and want the NHS – but there is a hefty bill to pay if we want to keep it.
The trouble is that the last thing the NHS needs is another major bout of restructuring. Some years ago I attended a meeting at the Department of Health when a restructuring was being proposed, by the then Secretary of State for Health.
Speaking later to a civil servant in the department I asked why there was a desire to change the whole structure rather than make incremental improvements. He stated that the only way any Secretary of State was going to make their mark on the NHS and be seen nationally to have done something was to restructure it. It was an eye-opening moment for me on the political motivation for change in the health service.
Politicians see restructuring as a way to change the NHS, however each tranche of reform takes years. Indeed, the last restructuring process is still not fully completed.
That will not stop many answers being put forward to solve the NHS’s problems, including privatisation, the merging of health and social care budgets and increasing taxation.
When it comes to privatisation we can look across the Atlantic to the United States, which is often cited as an example of a nation with good private health care. But this is not borne out by the analysis. Figures show it has the most expensive healthcare based on spend per head of population and no better clinical outcomes. A large proportion of those living in the US have no health cover and medical bills have been identified as one of the main causes of bankruptcy.
Over here, there has been much debate over the merits of merging the health and social care budgets. On the face of it this would seem a reasonable and sensible approach. However there are many pitfalls with this fairly simplistic solution. The governance issues, organisational changes and cultural challenges such a merger will create would be enormous. It would also bring another major restructuring that the health service can well do without. If politicians tried to argue this did not constitute a significant restructuring plan, it merely confirms their lack of understanding.
The funding for both health and social care come from different sources; health from general taxation and social care from a combination of government grants, user charges and council tax. There are also very different legal responsibilities on health and social care organisations. Healthcare is free at the point of delivery, whereas you pay for some elements of social care.
It is true that the effectiveness of social care directly impacts on the effectiveness of the healthcare system, however there is a danger that the present shortcomings in social care become confused with the issues facing the NHS.
What strikes me most is the lack of understanding by the politicians of the complexities of our health and social care systems. Evolution rather than revolution would be a more rational approach to confronting the challenges they both pose.
One of the NHS’s biggest problems is that it is overregulated and under-managed. It is a multi-million pound organisation employing nearly 1.4 million staff and therefore needs the management expertise and knowledge that any such business requires to be successful, working alongside clinical staff who are some of the brightest people in the country.
Simon Stevens, the chief executive of the NHS, has recently put forward a five-year plan. It focuses on clinical and cost effectiveness, productivity, innovation and the care experience of patients. The NHS needs to focus on delivering this plan rather than another restructuring.
Crucially, opinion polls have suggested that people would be prepared to pay more in taxation for the NHS to continue to provide services free at the point of delivery. One way to be clear on the funding stream for the NHS would be to use the National Insurance contributions which were originally set up to pay for an individual’s benefits in times of need.
Many would say that the original purpose of the contribution has been undermined by successive governments. In 2014/15 National Insurance will raise £106bn, of which just £21bn will go to the NHS.
The NHS is one of the most efficient health services based on international comparisons in regards to cost per head of population and the standard of care it provides. As with many other European countries, individuals of working age and their employers need to know that when they make contributions to the NHS through National Insurance, this is where their money is going. The National Insurance system is already in existence and therefore costs will be reduced. More importantly, people will know that they are paying for a defined benefit.
Ring-fencing is never popular with the finance people as it ties their hands. However if we really do believe the NHS should be our top priority then this is a solution that not only gives clarity but also ensures greater accountability for how our hard-earned money is spent.
• Henry Cronin joined the NHS in 1982 as a student nurse and spent the last 10 years of his career as an executive director in the North East of England. Since leaving the NHS he has worked independently on various NHS initiatives.