The NHS is broken and needs replacing


The NHS is broken and needs replacing

The time has come for politicians to admit to the public that the NHS as we know it is broken and that a new healthcare system is needed, argues Peter Bingle.

I have experienced the very best and worst of the NHS. With four children I have also been a regular visitor to A&E Departments at many hospitals. The experience has been varied, sometimes superb, sometimes less so. In this I am no different to anybody else.

I understand the public affection for the NHS. It is there when we are born, looks after us (with various degrees of success) during our lives and deals with most of us during our final moments. Yet the time has surely come for politicians (of all parties) to tell the public the truth and admit that the NHS as we know it is broken and a new healthcare system needs to be created which actually works. It is rather like coming to the very sad conclusion that a much-loved family pet is so ill that it needs to be taken to the vet and put to sleep.

In addition to having used the NHS all my life, I have also had the benefit of private healthcare insurance since the age of twenty-one. I also advised the Independent Healthcare Association at a time when Alan Milburn was a very radical Health Secretary and Simon Stevens was an equally radical health adviser to Tony Blair at Number 10.

The simple but brutal fact which needs to be accepted and then addressed is that there is a growing gap between the UK’s healthcare needs and the public’s willingness to pay for it. As this government has demonstrated beyond doubt, throwing ever increasing billions of pounds of public money at the NHS does not solve anything. The NHS’s appetite for devouring vast amounts of public funds is not only rapacious, it can never be satisfied.

So, what can be done? In an ideal world, the major political parties would come together and agree to a moratorium on NHS politicking. There needs to be a new political consensus on the need to be radical and brave.

But perhaps realpolitik means it will be impossible to bring a Corbyn Labour Party around the table to discuss a new approach to healthcare. If so the government needs to take the initiative.

Let me state at the outset that I am no expert in healthcare management and therefore offer the following ideas with the usual humility …

The first new approach should be for the government to include the independent sector in devising future healthcare policy. Milburn and Stevens did just that under Blair. Why not do it again now?

The second new approach should be to qualify the concept of healthcare free at the point of delivery. What is covered going forward should naturally be a matter of debate and extensive consultation but we can no longer afford a totally free NHS.

The third new approach should be to introduce a sensible charging policy for visiting GPs. It is done elsewhere in the EU and beyond and works well. There would obviously be the usual exemptions rather like NHS prescriptions. People who do not turn up for their appointment should pay a penalty.

The fourth new approach should be giving patients the right to use the independent sector if the NHS fails to deliver on its target for a particular treatment. A tariff system would need to be agreed with the independent sector. Again, this happened during the Milburn years.

The fifth new approach needs to be the merging of healthcare and social care into one system. Having to deal with more than one organisation when looking after an ageing relative or a handicapped child makes an already difficult situation even more stressful. It also cannot be the most cost effective or efficient means of service delivery.

The final new approach would involve the government asking Alan Milburn, Norman Lamb, Stephen Dorrell and other respected figures to come together to produce a new blueprint for a national healthcare system which works as opposed to an NHS which doesn’t work.

This is not a comprehensive solution to sorting out our broken healthcare system (it is simply a collection of thoughts) but the time has surely come to accept that the current system is broken beyond repair and needs to replaced. Until this happens the NHS will continue despite every best intention to fail us …

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  • Peter Bingle
    Peter Bingle
    Peter is the Founder of Terrapin Communications. With a career in politics and communications that has spanned almost four decades, he is one of the country's leading public affairs practitioners. His career has seen him advise many top companies, including McDonald’s, HSBC, L’Oreal, Permira, Motorola, Camelot, Rolls Royce & Kellogg's.
    • Derek

      Maintaining the services for an ageing population means an increasing load and spend as health declines, as does catering for the around 400,000 rise in population every year..
      Politics is the art of never taking responsibility especially when in charge.
      One way is to pretend that the same level of service is possible with an increasing load of service due to ageing and population increase and place the blame on the service provider.
      Perhaps the solution is for the public to become as obtuse as politicians?

    • Nockian

      My immediate concern is older people like myself who have paid for a life subscription through the taxation system, only to be told that they can’t have the service they were promised once they are close to retirement- the same went for pensions which were unavailable in most blue collar jobs in the 70s and 80s. The same goes for those that are part way through their working lives and have set up lives which revolve around a national health service.

      The problem is that costs are all towards the end of life and during the times of raising a young family. I don’t see why youngsters should be forced to foot the costs of the old, but if they don’t, then who will ?

      I’m a laissez faire capitalist, which means I believe in a completely free healthcare market without state interference. If we were beginning at year ‘dot’ this wouldn’t be an issue, but this isn’t the situation and we have what amounts to the best part of half a century of looking after existing NHS customers before things improve. It’s that kind of timescale that appears to put pay to any rapid changes within the service.

      We need health care to be less expensive and more effective, these are the rewards for moving to a proper free market in healthcare, but we appear to be light years from that destination and we have no ready mechanism which can span that great divide.

      However, to do nothing at all isn’t a solution and with the U.K. debt continuing to increase there doesn’t appear to be a simple sticking plaster to prolong the service. I think there is only a certain amount can be done to reduce costs in the short term, which means we have to look elsewhere (providing we can continue to manage the public debt) and I can only see one area in which public service could be sufficiently cut and that is education.

      With immediate effect we could move to a fully privatised school system within 5 years with a cut off date for match.
      We could get rid of the BBC license fee which would free up some cash for those getting free licences.
      Shelve HS2 indefinitely.
      Begin fracking immediately.
      Cut foreign aid completely.
      Sell the main road networks to private companies with taxation replaced by tolls.

      Then we need to get the economy functioning again and that requires savage cuts in subsidies for transport and anything other than health and security. I think we need to seriously review golden parachute public pensions and any salaries in excess of 3 figures. Expenses need pruning back hard. It requires a proper slash and burn effort which will be horrendously unpopular, but the Government isn’t supposed to be popular, it needs to small, cheap and effective.

    • The Third Man

      No serious analysis of NHS non-emergency care and funding model can conclude anything than it is an analog system in a digital world. The sooner we move to a part-insurance/part taxed funded model with protection/cover for the most vulnerable the better. Any experience of the different systems on the continent- France, Spain, Portugal – can only conclude that they all have better non-emergency outcomes, quicker service and more efficiently spent money, though yes, it is relatively more than the UK

    • corinium

      The NHS needs to be split into two bits – the emergency bit, which should be State funded and free to all, no charges. Everything else should be made into an insurance based system. The NHS does the emergency bit very well, and remarkably cheaply, and there’s no need to throw it away. There is zero point trying to replicate emergency care in a private sector way, it would be very inefficient to have more than one emergency unit in any given area. Where the NHS falls down is the non-emergency care, the type of care where the incentives of the staff and patient need to be more aligned.

      Its not difficult to explain – when someone is dying in the street after an accident, its blatantly obvious what needs to be done, human nature is such that no-one (hopefully) is going to do less than all they can to help a dying or heavily injured person. Unfortunately once that person is no longer dying, and in need of emergency care, human nature means that corners are cut, staff take the easy way out, don’t go the extra mile, after all why should they? They’ll get no more pay if they do, they won’t get disciplined, nothing happens to them if they give 75% effort instead of 100%. And there’s no way for the patient to express his dissatisfaction – he can’t take his business elsewhere, because by and large the NHS is a monopoly healthcare supplier for most of the population.

      What is needed in the non-emergency care part of the NHS is market forces – treat your patients poorly, and they won’t come back to you, and as result you may lose your job and salary. Thats the discipline needed -the ‘If I don’t treat these people well they won’t come back , and neither will their money’ discipline of the free market. No-one in the private sector provides good service out of pure love for their fellow man, its down to money – customers have it, and the supplier wants it. That is what is lacking in the NHS, the customer/service provider relationship. We get what they’re prepared to give us, and there’s SFA we can do about it if we don’t like it, and they know that. That is what need to change.

    • Fubar2

      Ive spent the last six months working for a CCG. The profligacy that Ive seen in purchasing just in this short time is nothing short of staggering. And thats just one CCG and there are dozens and dozens of them. The CCGs are awash with money, but they spend most of it justifying thier own existence, the amount of data analysts theyve got is frankly ridiculous – lakes of data with no clear way to interpret it for any other reason than the political to continue to justify the self licking lollipop that the system has become. The standard of leadership at CCG level and senior level is inadequate, but is sadly endemic across the whole of the public sector. Non clinicals do the bare minimum not to get fired. Absenteeism and staff sick leave to this level would not be tolerated in the private sector, let alone in a life and death area like health. There is no real oassion away from the clinical front line for what they are doung because the standad of leadership does everything it can to stifle it. Such qualities which the private sector laps up are seen by middle and senior management as a threat to their positions. Consequently the middle managers and team leads that they hire are put there to be controlled and to be a barrier, a human shield between them and the shop floor. Back office staff churn, because some CCGs recruit the cheapest buns on seats to fill established roles, as opposed to people passionate about what they are doing again, would not be accepted in the private sector. And even in the front line, where undoubtedly there are those who do work thier socks off and are dedicated, there are equally those in either nursing or clinical roles who see things that have been historically key aspects of caring as being beneath them.

      The thing that really cripples it is the lack of leadership and vision more than anything else. Its not money. Its not even really the structures. The private sector where it is involved is inadequately managed and measured, which means they run rings around the contract managers and the service standards suffer as a result, because the suppliers know there are no consequences during the contract lifecycle for poor performance. It needs someone to shake it out of its “you cannot criticise us, we’re untouchable angels” false security and show it some real direction. At the moment that is pretty much completely absent.

    • Pat

      Not so much broken as obsolete, an anachronism.
      In 1948 money transfer was vastly more expensive than it is today, hence to make sure that everyone could afford healthcare had to be done by central provision. Now the Singapore system is more practical.
      In 1948 travel was vastly more expensive than it is today and international travel vastly more difficult (Mr. Atlee’s rules on immigration would horrify the modern left), hence health tourism didn’t happen, healthcare for immigrants was minimal (few immigrants allowed).
      Lifetimes have considerably extended since then, thus there are more elderly people (and they are the ones using most care)
      There has been a decline in the birthrate, reducing the proportion of the population paying in.
      Newer and better treatments are also more expensive.
      Finally there has been a cultural shift. In 1948 people were too proud to accept free treatment unless they really needed them, nowadays not so much.
      The NHS today serves best the interests of its staff, who get to be regarded as saints (the public forget that they work for money) and they get to negotiate pay and conditions with politicians spending other people’s money, rather than people spending their own.

    • geo

      you allow immigration to push up the population by 10 million, you allow health tourism to the value of billions, you allow ridiculous operations like leg lengthening and cosmetic surgery on the nhs. you continually refer to the nhs as the best in the world when no other country on earth has followed this model because its inherently unaffordable – not even the french … and one uk political party spends its entire time ensuring that the nhs is so sacred a cow that it can never be changed. any attempt to make it affordable generates screams of angst and accusations of nazism from the liberal left.

      it is then a surprise that every single year for the last 30 years that the nhs is in crisis. seriously? a surprise?

    • Guy Family

      Public affection for the NHS is a myth. There may be public concern that the NHS will not be there in times of need. But affection? No. The NHS is, along with the UK benefits system, a sacred cow that no government will ever reform for fear of losing voters.

    • Philip Meikle

      The NHS like pensions is a massive PONZI/Pyramid Scheme. Ageing demographics is the same effect as a PONZI/Pyramid scheme which has no new members and everyone starts realising that there is no magical money tree and they are about to loses everything. Why else would the government make compulsory pensions for everyoone a requirements. And now the talk of retiring at 75… Everyone under 40 is totally screwed. The UK is going to have massive social issues in the next 20 years and its a shame that our generation will be the ones that bear the brunt.

      • gelert

        The line is the system in France – a system created before the 1948 annus mirabilis of the NHS . A blend of government and insurance. Serious illnesses are 100% covered by the government. Less serious are 65 – 70% covered. Insurance can be bought to cover what’s not covered by the government.

        Those below a certain income level are 100% covered.

        I’ve lived in France for several years and am really impressed. There is also not the age discrimination practised in the UK. An added bonus is the respect for human dignity; no rude nurses who insist on calling the elderly by their first names or, even worse, as Grandma/Grandad.

        • Nockian

          It was once the case that those involved in accidents footed the bill for the emergency services, which seems reasonable to have some sort of limited cover for breaks, cuts, abrasions etc, although the insurance companies are struggling to keep premiums low due to the monetary madness of our central banks – it’s all linked. The state owes too much, the banks keep interests rates artificially low, investors requiring security are wiped out, the cost of the kind of insurance which would be useful in this case becomes unaffordable.

          • gelert

            France bills insurance companies for motor vehicle injuries and I believe the same applies to work-related injury.

            • Nockian

              That would make sense, it could be done. I don’t know why it stopped in the UK ? I remember being told I would get a bill after crashing my motorcycle in the early 80s, but never saw one.

    • MrVeryAngry

      “…devising future healthcare policy…” That presupposes that a healthcare system can be centrally designed. It can’t. As the NHS proves. Better to de-nationalise the whole thing and then set up a voucher system that covers chronic conditions that are commercially uninsurable and critical emergencies. Then get the bloody government out of the Damn’ way.

      • Nockian

        What do you do with those who never expected to need insurance and are now unable to afford it having paid in a lifetime of taxes ?

        I agree the state has to get out of the way, but how to get from here to there seems like building a bridge to the moon.

    • Derek

      The UK is known for it’s low productivity. Combine that with ageing demographics and spending per person will be continually reduced in future as the alternative is debt rising through the roof. There’s no “cure” for ageing demographics as too many are already in the various age groups and today many live into their 80s and beyond. If you accept it is impossible to raise UK productivity then the only way for public spending is down, down, down as ageing demographics bites harder and harder in the future..

      • thamesmud

        “Productivity” will not rise unless automation is introduced, at the moment business in the UK has no incentive to invest in expensive machinery as there is an almost infinite pool of cheap labor and no commercial pressure not to employ them. Contrast us with the French, access to the same labor pool but hugely restrictive employment practices make the cost of labor high relative to automation. A balance needs to be struck maintaining high employment at increased wage rates thus increasing the government tax take, whilst encouraging business to invest to increase productivity and to sell the “products” either good or services in the world market. Leaving the EU will help in constraining labor supply but business and the country as a whole, needs to step up and government get out of the way for us to trade our way out of the mess we are in.

    • Mike Hunt

      Might save some money if they stopped treating the world for free and trendy gender re assignment operations

    • A real liberal

      The NHS is no more broken now than it was in 1948. To suggest so – let alone to suggest that this is the moment when the brokenness requires critical action – is to show a lack of study. The NHS is always ‘broken’, ‘in crisis’, ‘at the tipping point’, suffering ‘lowest morale’, ‘losing its best people’. It’s the nature of the beast. It’s all a game constructed by NHS professionals; their shroud-waving professional bodies; and journalists like Mr Bingle, in which we all connive. And actually quite enjoy. We’ve got lots more money, many more years and many more articles to throw at the NHS yet. And even if we didn’t have, we’ve a hundred times more misery to mawkishly enjoy before we’d even consider reforming ‘our NHS’.

      • Nockian

        I know where you are coming from, but I think we are at the beginning of a flood, not in the middle of it. Public debt is continuing to rise and markets will punish the borrowers with higher interest rates at some point. It looks like the perfect storm-stagnant productivity, marginal (at best considering the cash thrown at it) GDP recovery, massive public debt and expanding private debt, people growing older-particularly baby boomers like myself, a collapse in savings, the beginnings of real world inflation of prices due to a lower value of exchange.

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