Insurance may yet hold key to improving our health service
THE excoriating criticism by Dr Peter Bennie, chairman of the BMA in Scotland, of the SNP’s stewardship of the NHS in Scotland (NHSiS) is timely, but yet another request for a frank debate between politicians, the public and the health sector will sadly fall on deaf ears (“SNP priorities on health all wrong, says leading doctor”, The Herald, December 27). It is widely accepted across all sections of society that the NHS, whether as currently operating in this country, or in its latest “reformed” structure in England, is not sustainable. Politicians seem unable to finally admit what many doctors, journalists, academics, health care workers and indeed members of the public now accept, that no amount of tinkering with a myriad of budgets will cure its problems.
Many economists calculate that the NHS needs a three to four per cent increase in funding every year to keep pace with demand. Unsurprisingly, politicians of all parties, and indeed the public, seem unable to accept the tax increase required to fund this. With the hollow claim to be the guardians of the NHS saving it from “privatisation”, and by threatening to vote in Westminster on English-only matters, the self-righteous hypocrisy of the SNP diminishes its validity as a party with any financial credibility. “Privatisation” already exists in the NHS, and although the SNP claims that taxpayer cash spent on private health services is only used in exceptional circumstances, independent analysis shows that this has doubled since 2000 to £82.5 million by 2015, is still increasing, and by 18 per cent above inflation in the past five years.
Ironically, it was the “new” Labour government of Tony Blair that was responsible for PPI procurement which introduced an enormous amount of private money, and debt, into the NHS. Simultaneously, it funded “waiting list initiatives” and I remember performing operations in Glasgow’s private hospitals at weekends, allowing patients to have their procedures carried out sooner in the private sector, in order to meet political targets. I only recall one patient declining, preferring to wait longer, until sent for by the NHS. There already seems to be general acceptance that many patients will pay a contribution to dental care, patients in Ireland are accustomed to paying a fee for attending their family doctors, but the cultural shift required to accept a health care system with a greater input from the private sector is perhaps too fundamental to be acceptable to those living in Scotland.
However, despite Shona Robison’s assurance that the National Clinical Strategy will provide the answer to the long-term funding problems of the NHS, the alternative of some insurance-based top-up, as used in some other European countries which provide excellent health care, may become inevitable. Regrettably, our politicians do not have the courage and maturity to articulate this, and the public the disillusionment yet to contemplate it. Even with a socialist president, France was deemed in 2015 to have the best health service in Europe by one independent research centre. Although additional funding came from social and private insurance, those on low incomes were still treated free. Perhaps the answer to Scotland’s ongoing health care crisis lies with our auld allies over the water. John Sinclair, FRCSE, 7 Bridgegait, Milngavie. DR Peter Bennie has highlighted the excessive demands placed on NHS staff. Opposition politicians blame cuts to criticise the running of the service by the government in power.
Clearly the NHS needs restructuring and reform, and at last the SNP will start this year. Let’s hope it has learned from the Police Scotland debacle. And let’s hope it doesn’t just complain about how much money it gets from Westminster, because since 1965 UK GDP had trebled in real terms from £470 billion to £1,500bn, and spending on the NHS has doubled from four per cent of GDP to eight per cent, so arguably resources have grown six-fold without satisfying demand. So what has changed?
One factor that politicians never mention is the excessive demands we, the consumers, make on the NHS due to lifestyle and attitudes.
Diabetes is an example. In 1965 there were around 50,000 people with Type 2 diabetes in Scotland. There are 250,000 today. It is caused by obesity, can be avoided or cured by weight loss and the disease and its associated symptoms and implications costs around £1bn out of NHS Scotland’s £13bn budget.
And no wonder our ambulance service is creaking if, as a recent report highlighted, weekday manning has to be adjusted to cater for 42 per cent of weekend ambulance callouts which are for drunks with self-inflicted emergencies.
And what chance do our doctors have if, for example, only 1.3 million out of 2.1 million Scots invited to take the simple home bowel cancer screening test take up the offer, meaning only 4,000 out of a possible 7,000 bowel cancers are discovered and treated early, successfully and at less cost?
Our responsibility as consumers of healthcare needs to be highlighted, and there needs to be cross-party support for education, screening, food marketing and manufacture legislation. This should be reinforced by incentives such as paying for weight loss and consequences such as delayed non-life threatening operations. Both these initiatives are happening in England.
There are huge gains and improvements to be made and it is time that we started calling a spade a spade. Politicians are scared that they will offend the voters, but they will offend those of us who pay our taxes and look after ourselves even more. Allan Sutherland, 1 Willow Row, Stonehaven.