Although funding and medical resourcing such as staffing and hospitals
dominate the debate on the NHS, the balance between public health
requirements and individual medical needs is the real issue.
In remodelling the NHS, the government follows a global trend of policy
shifting (here and here) from a model of all possible care for everyone, to one which
delivers high-quality essential care to all based on
cost-effectiveness. To facilitate this, elements of market-oriented
economy are adopted to varying degrees in the hope that they will be
matched by individual exercise of choice and responsibility. Real
market benefits are unfortunately limited as rationing continues based
on what services the government can finance and deliver. Furthermore,
any rationing that excludes whole groups of the population is
unacceptable, even though it is impossible to provide every conceivable
service for everyone.
As the NHS begins to specify its exclusions, the ethical argument will
centre on the premise that taxes are paid into a health system that
does not deliver all the expected services. Included will be such
matters as impairment of individual right to life, and the use of
potentially beneficial but expensive treatments that are unavailable
from tax-funded provisions for otherwise debilitating or
This government failed to take into account these matters of social and scientific development in its NHS modernisation programme, while increasingly complex and expensive management systems are introduced with unprecedented levels of funding. The core issue is therefore not funding per se, but rather reform of government stewardship and the containment of waste. While existing financing arrangements for health through general taxation may be acknowledged as the best way of paying for healthcare on the grounds of equity and efficiency of collection, there are other means of fulfilling these criteria. Indeed, on the consumer side, the collective purchase of services loses out on the advantages of competition among the providers that is engendered by direct individual participation in the market.
So we must aim to promote personal financial autonomy. The positive outcomes of this would be the development of consumer-responsive healthcare delivery and efficient systems of management (here and here). These would replace the large administration that is a drain on public finances. Such a transformation of ideological approach to health would also ensure the prominence of compassion in care delivery over the current obsession with targets, so inept in many of its applications.
The resultant health system would establish community-based funding pools (here, here and here) for GP and other primary care services. These would genuinely effect direct patient empowerment, the mantra hoped for by this government. The next stage would include the realignment and integration of primary, secondary and tertiary care services led by the medical profession (here and here) rather than the haphazard manipulation and interventions by the government. Major high-cost and high-complexity treatments, emergency and trauma, and chronic care would remain the remit of a centrally funded NHS. This would obviate the antagonism inherent in the current system of funding for primary and secondary care. Realignment of medical manpower training and retention of personnel would also be addressed in parallel with the build-out of a new health system (here and here).
This proposal, which in essence promotes universal private ownership of healthcare, would recover the principles of the NHS. The pathway for its implementation, the advantages and the benefits of the proposed health system have been showcased at the Policy Forum on Health held at the University of Leicester in 2003, with guest speakers that included Shadow Health Secretary Andrew Lansley and Nick Bosanquet, Professor of Health Policy, Imperial College.
In the tripartite compact between the public, the government and the medical professions that formed the basis of the NHS (here), the government has become too big. The new proposed health system would reconnect the public and the medical professions more effectively, revive doctors’ morale (here, here and here), reduce bureaucracy, improve accountability and efficiency, enhance patient choice and care, and while at the same time emphasise the stewardship role of government in healthcare delivery.