Life – Terror. Ecstasy. Fight. Denial. Flight. Failure. PAIN. Forgiveness. Reconciliation. Hope. Love. Peace – Death.
This morning I had a post-op appointment, a re-dressing, a follow up to a surgical procedure, performed, at a private Hospital, Spire, paid for by our NHS. Not an unusual occurrence, many minor procedures are being delivered this way, an effort to try and reduce current, record breaking, (6.5 million) waiting lists.
I arrived bang on time, 10.00AM to a small queue forming at reception. A rather intense ‘reception manager’ came from behind the desk? Was working his way thru the small queue. He politely asked the couple in front of me ‘what is the nature of their visit (appointment)’? Followed by ‘are you an NHS patient or Private’?
Facing their backs I did not hear any answers.
The couple advanced to reception. I was asked the same question, ‘I am here for a post-op redressing’ I replied, curtly. ‘Yes, this is the correct queue’, he stated. I was waiting for the NHS question that never came. The Queue man withdrew, back behind reception where he remained, looking over the shoulders of two receptionists, seemingly checking their input.
I suspect his previous mission motivation had been to remove the queue. Queuing in a private hospital? Not a good look for paying customers, patients arriving, on time, for appointments? Private patients don’t queue?
The couple in front had now reached the desk and were asked again ‘are you an NHS or Private patient?’ Simultaneously, after I had given my name and told ‘my’ receptionist ‘I have an appointment for 10.00AM’ I was instructed to take a seat, ‘somebody would call my name shortly’.
I sat and waited, two more patients arrived at reception ‘are you NHS or Private’? The queue had now dispersed, ‘Queue Man’, remained behind reception, silent, hovering, examining, one receptionist’s ‘work’ in particular. My appointment was with my consultant, Mr Browns clinic. A specialist nurse, in charge of re-dressing my wound. She called my name and we walked together to a small bay where she removed the old dressing, cleaned the wound and demonstrated some physio exercises I had to perform from that point on. The nurse was kind, professional and very good at her job.
Previous appointments, pre-op, I noticed that consultants acted differently depending upon if a patient is NHS or Private. Whilst sitting waiting to be called, consultants would emerge either left or right from two corridors adjacent to reception.
If greeting an NHS patient the consultant would call out a name and then immediately start to retreat back thru the open doorway, with their patient following behind. If it was a private patient the consultant would extend their hand, introduce themselves, whilst shaking the patient’s hand and holding the door open, following them into the corridor.
A really simplistic example of two-tier health services in action.
I have to admit this observed behaviour made my blood boil. I was furious. I am furious. It makes me want to scream. It certainly didn’t endear me to ‘my doctor’ Mr Brown when he did it to myself. I was left feeling that the person responsible for cutting me, treating me, healing me is probably an ignorant snob.
The National Health Service was created in the aftermath of the Second World War, amid efforts to rebuild a better society. For the first time, healthcare was available to everyone regardless of their ability to pay. An unprecedented number of healthcare workers were needed to realise this grand vision.
Much of the healthcare system prior to the NHS was already reliant on healthcare workers from overseas – in particular from Ireland and Central and Eastern Europe. Immigrants, often highly qualified, experienced immigrants. Among them were displaced Jewish refugees escaping from Nazism.
The current UK health and care system is under intense pressure, with rising waiting times, persistent workforce shortages and patients struggling to access the care they need. A direct hangover from BREXIT and the COVID Pandemic. As a result, patient and public satisfaction with services has dropped significantly, prompting debate and discussion about the future of health and care services. In the context of what can feel like a heated political and media discussion, there are some myths and truths that feature in this debate.
Myths & Facts
Some commentators and politicians have labelled the NHS a bottomless pit – the more money it receives, the more it demands. They argue that the NHS consumes too high a proportion of public spending and that continuing to increase health spending is unsustainable – the more money it receives, the more it demands.
Myths & Facts
Spending on health care has historically grown by about 4 per cent each year in real terms in the UK. This is due to a combination of factors including a growing and ageing population, rising patient expectations and medical and technological advances. Like other nations, we have chosen to pay for this by prioritising investment in our health system from the proceeds of economic growth by direct & indirect taxation – income tax and national insurance contributions.
In the decade following the global financial crisis in 2008, the health service faced the most prolonged spending squeeze in its history: between 2009/10 and 2018/19 health spending increased by an average of 1.5 per cent per year in real terms, however, still well below the long-term average.
As a result, spending failed to keep up with demand, increasing the pressures on services and leading to staff shortages, rising waiting times for treatment and performance standards being routinely missed, well before the pandemic.
n 2018, the government announced a five-year settlement for some areas of health spending, covering the period from 2019/20 to 2023/24. Under this deal, NHS England’s budget would rise by an average of 3.4 per cent each year in real terms.
As a result of the additional pressures created by the pandemic, this was followed by a new three-year funding settlement in September 2021 to increase Department of Health and Social Care’s resource budget (day-to-day spending) by an average of 3.8 per cent each year until 2024/25. This uplift is part-funded through an increase to National Insurance Contributions, known as the Health and Social Care Levy.
As public spending on health has increased, it has consumed a larger share of government expenditure. Spending on the NHS now accounts for more than 20 per cent of all public spending (and more than 40 per cent of day-to-day spending on public services), leading to trade-offs with other areas of government spending. However, this should also be seen in the context of the UK’s relatively low tax revenues compared to many other countries.
In 2019, the UK spent 9.9 per cent of its GDP on health, remaining consistently around this level since 2011. This is slightly above the average for members of the Organisation for Economic Co-operation and Development (OECD) but lower than several comparable nations, including Germany, France and the Netherlands. Evidence also suggests the NHS is relatively efficient.
Compared to other countries, the UK does not spend a particularly high proportion of its national wealth on health care, while a decade of historically low funding increases has left services facing huge pressures and a workforce crisis. Like levels of taxation and public spending more generally, how much is spent on health is a political choice and politicians should be honest with the public about the standards of care they can expect with the levels of funding provided.
Some, mainly left-wing, commentators have argued for many years that the NHS is being privatised. Private companies have always played a role in the NHS, with services such as dentistry, optical care and community pharmacy being provided by the private sector for decades, and most GP practices are private partnerships.
Myths & Facts
The NHS and the private sector have also established partnerships for the delivery of clinical services such as radiology and pathology and non-clinical services such as car parking and management of buildings and the estate, while independent hospitals (e.g. Spire) have been used under successive governments to provide additional capacity in response to pressures on NHS services.
Identifying how much the NHS spends on the private sector is not straightforward but estimates can be made using data from the annual accounts of the Department of Health and Social Care.
…spending by NHS commissioners on services delivered by the private sector increased to £12.2 billion in 2020/21. However… this again represents only around 7 per cent of the total Department of Health and Social Care revenue budget.
Throughout the Covid-19 pandemic, the Department of Health and Social Care and the NHS entered into new contractual arrangements with the independent hospital sector to increase capacity. These arrangements provided access to additional beds, staff and equipment to treat patients during the peak of the pandemic and are being used now in some places to support efforts to reduce how long people wait for routine care. As a result, spending by NHS commissioners on services delivered by the private sector increased to £12.2 billion in 2020/21. However, in the context of the significant additional funding provided in response to the pandemic, this again represents only around 7 per cent of the total Department of Health and Social Care revenue budget.
The Health and Care Act 2022 removed the competition and market-based approaches introduced by the 2012 Act. This gives commissioners greater flexibility over when to use competitive procurement processes, reducing the frequency with which clinical services are put out to tender.
The independent Commission on the Future of Health and Social Care in England. In it, the commission discusses the need for a new settlement for health and social care to provide a simpler pathway through the current maze of entitlements. The commission, chaired by Kate Barker, proposes a new approach that redesigns care around individual needs regardless of diagnosis, with a graduated increase in support as needs rise, particularly towards the end of life. The commission has concluded that this vision for a health and care system fit for the 21st century is affordable and sustainable if a phased approach is taken and hard choices are taken about taxation.
- The commission recommends moving to a single, ring-fenced budget for the NHS and social care, with a single commissioner for local services.
- A new care and support allowance, suggested by the commission, would offer choice and control to people with low to moderate needs while at the highest levels of need the battlelines between who pays for care – the NHS or the local authority – will be removed.
- Individuals and their carers would benefit from a much simpler path through the whole system of health and social care that is designed to reflect changing levels of need.
- The commission also recommends a focus on more equal support for equal need, which in the long term means making much more social care free at the point of use.
- The commission largely rejects (new) NHS charges and private insurance options in favour of public funding.
As an active customer of the NHS, I cannot praise them highly enough for my, now constant, treatment and care for several chronic conditions. However, could NHS health care be improved in any way? Of course, it could. ultimately, it comes down to a choice, a difficult choice but still a choice. Do we fund it satisfactorily or not?
Privatisation would not be ‘my’ answer.
For me it’s a no brainer. Privatisation = Profit. The prime motivation for effective health care cannot be profit. In that model the patient can only come second to the demands of shareholders, to greed, to the compromise of an inferior quality of care delivery based upon cost effectiveness.
Thanks for reading