The end of the NHS as we know it?

Worth A Look, Healthcare & Welfare, Frontier Centre

A group representing all points of the political spectrum, including senior NHS consultants and prominent Labour party members, has recommended a radical set of evolutionary changes to the delivery of health care in the UK.

The Health Policy Consensus Group examined all leading overseas systems and concluded that we had most to learn from the countries which have social insurance systems, such as Germany, France and Switzerland. Six characteristics of an effective health system were determined:

1. The primary role of government should be to create the legal and regulatory framework, to ensure that access to a high standard of care is guaranteed to all, and to ensure the supply of essential public health services.

2. Patients should have a choice among a range of competing healthcare providers.

3. Health insurance should be compulsory.

4. Patients should be free to choose from among a range of third party payers so that the allocation of resources follows from patient preferences.

5. There should be no compulsory user charges.

6. Politicians must not override the professional duty of clinicians to act in the interests of patients.

A new consensus for change?

The chairman, Dr David Green said: “Current policies are self-contradictory. The Government increasingly advocates consumer choice and yet the NHS remains a highly centralised public-sector monopoly”.

“The NHS used to be a major ideological battleground producing bitter divisions whenever change was proposed. But the Government has been slow to detect a radical change in public opinion. The Consensus Group was selected to represent all points of the political spectrum, with strong over-representation from the centre-left, and found that discovering a new consensus was not difficult.”

Members included Professor Steve Smith, NHS consultant and long-standing Labour party member; Labour peer, Lord Meghnad Desai; Stephen Pollard, Labour party member and former research director of the Fabian Society; Geraint Day, member of both the Labour party and the Co-operative party and a researcher at the IoD; Paul Ormerod, Labour party member and author of The Death of Economics; Anthony Browne, formerly health editor of the Observer; as well as other distinguished journalists, academics and writers, including Andrew Neil.

The Group concluded that the ultimate aim should be a system based on health insurance, not taxation. The NHS cannot continue as it is. Internal reform to open up a few more options for consumers defined by government officials will not be enough. Nor will giving a bit of autonomy to a dozen or so hospitals.

Reform of the method of finance is vital so that people can decide how much of their own money to spend on health care and simultaneously determine the standard of care to be enjoyed by less fortunate members of society. Services should be provided by competing hospitals with a mix of public and private ownership.

Evolutionary change

The Group did not recommend a single sweeping solution but a series of evolutionary changes. Four main options were identified. The simplest involves reform of primary care trusts, permitting individuals to choose another PCT if dissatisfied. Other possibilities included a treatment voucher and social insurance along Swiss lines.

The most radical would give us all the chance to become Mutual Members of the NHS or to remain as Ordinary Members.

What would becoming a Mutual Member entail?

  • We would all pay taxes as now.
  • Everyone would be free to choose to become a Mutual Member of the NHS by joining a health care purchasing co-op.
  • The co-op would provide information about insurers and bargain with them on behalf of its members.
  • The government would pay Mutual Members a minimum of 70% of the cost of the insurance premium as a tax credit. For example, a couple with two children paying £3,000 a year would get back £2,100, leaving £900 to pay.
  • People unable to work would have an equal right to become Mutual Members.
  • As an optional extra, the tax credit for people on middle incomes would be reduced to as low as 60% to reflect the additional cost of extending choice to less fortunate members of society.
  • A new ethical basis for the NHS: honesty in payment

    We need to put the NHS on a more solid ethical footing. Most members of the public want better standards of health care, but are reluctant to pay higher taxes. Is this a sign of voter inconsistency, or is it an inevitable consequence of a system that prevents people from seeing clearly how much they are paying and what they are getting in return?

    There are those who argue that payment for the NHS through taxes creates a kind of social solidarity, but it is more common to recognise that reliance on taxation creates a conundrum. There are two weaknesses: it is not only a bad method of consumer payment but also an inadequate method for encouraging the well-off to support the poor.

    First, payment through taxation means that we are unable to tell how much we are paying, let alone how our payment translates into the standard of care available where we live. No rational person would be willing to pay more without being able to tell whether the price was good value for money.

    Second, years of party-political manipulation of public opinion have left most people uncertain whether they are net payers towards the NHS or net takers. Many politicians prefer to patronise voters and keep us all guessing about whether we pay in more than we take out. In a mature democracy payment should be more open, so that we all know where we stand.

    People choosing to become Mutual Members of the NHS will be opting to be net contributors, taking responsibility both for themselves and less fortunate members of society. According to the chairman, David Green, “The new system will help to build a real sense of social solidarity based on the conscious knowledge that we were contributing to a system that serves as a system of insurance for rich and poor alike.”

    Members of the Health Policy Consensus Group

    Professor Nick Bosanquet, Imperial College; Anthony Browne, former health editor of the Observer, now environment editor, The Times; Dr. Adrian Bull, formerly PPP Health Care, now Carillion Health; Geraint Day, Institute of Directors; Professor, Lord Meghnad Desai, London School of Economics and Labour peer; Helen Disney, Civitas; Dr. David G. Green, Civitas (Chairman); Benedict Irvine, Civitas; Ruth Lea, Institute of Directors; Dr. Christoph Lees, NHS Consultant, Addenbrooke’s Hospital; Andrew Neil, formerly editor of the Sunday Times, now a broadcaster for the BBC; Paul Ormerod, Volterra Consulting and author of The Death of Economics; Stephen Pollard, journalist and Labour party member, Research Director of the Fabian Society 1992-6, now Senior Fellow, Centre for the New Europe; Professor Stephen Smith, NHS Consultant and University of Cambridge; Matthew Young, Adam Smith Institute.

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