How now the NHS?
Frank Booth, RGN
Funding the NHS
Over 15 million people in England have a long term condition (LTC). They make up a quarter of the population yet they use a disproportionate amount of NHS resources: 50% of all GP appointments, 70% of all hospital bed days and 70% of the total health and care spend in England. Many patients within NHS establishments no longer need active NHS care but there is no available and suitable ongoing social support/care.
This suggests an opportunity manage such patients more intelligently, for example, encouraging self-care based on an understanding of individual risk. Such an approach, along with other Government policies is designed to improve health and reduce spend. But is it working?
The NHS – a history lesson!
The principles of the NHS were to provide a comprehensive service funded by taxation, available to all and free at the time of need. According to Beveridge, a nationalised health service was just one way Britain could help beat want, disease, ignorance, squalor and idleness! On 1 December 1942 the 'Social Insurance and Allied Services’ report was published [1]; this became the blueprint for the modern British welfare state.
On July 5, 1948 the National Health Service took control of 480,000 hospital beds in England and Wales and provided 125,000 nurses and 5,000 consultants to care for hospital patients.
The NHS today
Healthcare is becoming more personal; recent biomedical advances suggest a revolution in medicine that could enable clinicians to tailor treatment to individuals’ specific characteristics. For instance, it has been proven that mutations in two genes called BRCA1 and BRCA2 significantly increase a person’s risk of developing breast cancer. Individuals can now be tested for these mutations, allowing early detection and targeted use of therapeutic interventions. Similar progress is being made in understanding the biological basis of other common diseases.
The health service needs to consider how to invest in this work and how it can most effectively be translated into everyday practice. Health screening may benefit the person and the public purse by moving away from a ‘one-size fits all’ model of care.
All too often we see health expenditure as purely a cost, but investment in individuals’ wellbeing and productivity delivers vast benefits to society and the economy. Conversely, illness costs the UK economy; in 2011, 131 million work days were lost due to sickness. This translates into an annual economic cost estimated to be over £100bn, whilst the cost to the taxpayer including benefits, additional health costs and forgone taxes, is estimated to be over £60bn.
Can the NHS cope?
Today we can and do undertake surgery on/for things that only 50 years ago we would have in all probability have died from. Have we gone too far? Do we expect/demand too much of our NHS? Is it realistic to truly believe that ALL care should be free at the point of contact? I am not completely convinced any more that this should be the case…
Medicines cost
The World Health Organisation [2] suggested that in long-term conditions, only 50% adherence to drug regimens is achieved (globally). In 2011 the BMA [3], recognising that resources were wasted because patients could not return unopened dispensed medications to pharmacies, commissioned an independent study to explore the re-use of medicines. The report 4 found that unused prescription medicines costs the NHS at least £300 million per year in England, 50% of which was avoidable.
Research from the York evaluation concludes that the optimal use of prescribed medicines in just five therapeutic areas – asthma, diabetes, high blood pressure, vascular disease and schizophrenia – would generate up to £500 million of extra value.
Patient’s responsibilities?
The media report that patients’ complain that they cannot obtain a GP or Nurse appointment within the prescribed time, usually the same day for the very urgent, and within 48 hours for other care. From speaking to colleagues, both medical and nursing, it becomes clear that there are several very obvious problems; for example, patients who do not turn up for appointments despite text or phone reminders, or patients who attend simply to tell the GP that the action or prescription prescribed the week before is working/has worked. Is this really necessary to take an appointment? Would a phone call not suffice?
I wonder today whether we would object to paying for a GP appointment; £10.00 for example? Perhaps wasted appointments would significantly fall and if they did not, then the funding would supply extra staff. And should this apply to A & E? Many illnesses occurring on a Friday, Saturday or Sunday evening may be self inflicted… Yet you and I have to pay for this within our taxes. You and I (and I have personal experience of this) have staff taken away from us at a time of critical care need as they are dealing with people who are abusing and haranguing them. The can fine you for public order disobedience in the street, why not in hospital? This charge should be meaningful, say £100.00. If you can afford to drink so much alcohol to take your body to a level where you are stupefied, then perhaps you deserve the fine.
In any event, is every appointment with nurse or GP really necessary? Is it possible the services of the pharmacist be utilised? Pharmacists offer a great service in relation to drug matters, reactions, interactions and adverse responses can and can provide a more rapid response.
Conclusion
Not everything in life can be free. It seems even in this economic climate that we still expect that our NHS has to be. I absolutely agree that where real and clear justifiable clinical need exists, then no charge should apply, but not when we abuse the service; when we permit ourselves to overdose on alcohol then the NHS should not be expected to foot the bill.
During the past decade however, I have been glad that I live in a society that provides healthcare for the sick. Healthcare, free of charge at the point of need and cost is not overly considered it is only clinical need. We are a small nation with many costs but our health and well being, our safety and security and our ability to work and generate income are important to a civilised nation.
We have a First Class Service that we really don’t want to lose, so someone must pay. There is no magical ‘Pot of Gold’. You pay, I pay, we all pay or we don’t have the best. Still there are ways to reduce costs sensibly and reducing abuse has to be the obvious starter for 10, doesn’t it?