Today's reports of UKIP leader
Nigel Farage once again talking about the future of the NHS and the part that
private healthcare provision might play in it, will undoubtedly be manna from
heaven for some of his political opponents, who will almost certainly claim
that his remarks represent positive proof that Farage and his party are not
only ardent supporters of an entirely privatised healthcare model, but are also
being dishonest with the British public about their plans to safeguard our existing and highly valued free at the
point of delivery National Health Service.
Of course what these same
opponents and critics of UKIP will probably fail to mention is that the part
privatisation of the NHS has already begun, with around 6% of the service's
total budget, approximately £6bn, regularly finding its way into the private
healthcare sector, where a corporate profit motive is just as important, if not
more important than the actual clinical outcomes. It is also worth recalling
that it wasn't UKIP that approved any of the contracts with these private
healthcare providers have benefited from, but rather it was the three big
legacy parties, the Conservatives, Labour and latterly, the Liberal Democrats.
In addition it is these same three mainstream parties who have been responsible
for saddling the National Health Service with tens of billions of pounds worth
of long-term debt in the form of PFI's, the Private Finance Initiatives that
have allowed private building consortiums to make vast profits through the
provision of overpriced and expensively maintained clinics and hospitals. So
right from the outset, it would be extremely hypocritical of any Labour,
Conservative or Lib Dem supporter to point any fingers at UKIP, a party that
has played absolutely no part in helping to undermine the NHS, when the likes
of David Cameron, Tony Blair, Gordon Brown, Ed Miliband, Jeremy Hunt, Andy
Burnham, Nick Clegg, Vince Cable, Shirley Williams and the rest of their
individual party cohorts have done exactly that, not only undermined the
service, but also aided and abetted in the part privatisation of the NHS, both
directly and indirectly.
Those obvious, undeniable and
historic facts aside, even those of us who value the existence and daily
live-saving performance of the NHS probably recognise that in its present form
and with increasing levels of clinical obligations foisted on it by an ageing
population, the current NHS model is neither sustainable, nor easily
affordable. It may be an unpalatable truth, but at some point in the future
we're going to have little choice but to either scale back what the National
Health Service does or doesn't do on a daily basis, or we're going to have to
pay a great deal more through our taxes, or through personal private
subscriptions, ie: private healthcare. It is absurd for anyone to suggest that
the NHS can keep being given increasing amounts of taxpayer money to meet
increasing numbers of clinical treatments, because the logic of such an
approach will inevitably mean that public monies will have to be drawn from
elsewhere, such as our Armed Forces, our Welfare Services, our Schools, our
Transport infrastructure, until eventually every penny of revenue is being
sucked into the financial black hole that the NHS becomes.
However, although Nigel Farage
runs the risk of being shot as the messenger, simply for delivering an unwanted
and unwelcome message about the NHS and its future funding, in his own personal
view, as is the case with most of these things, there really is no right or
wrong answer, no absolute, when it comes to figuring out how to pay for an
entire country's health needs. Different countries around the world employ
different healthcare models, some are based on public subscription, others are
based purely on private means, while others again are based on a mixed
public/private model. Each in their turn have their benefits, just as they have
their underlying problems, but we can argue until the cows come home which is
the better system and which is the worst, but ultimately they're nearly all
based on the patient having put their hands in their pockets at some time or
other, they just do it in different ways and at different times.
The main problem for our beloved
NHS seems to be that as each year and each government passes, our healthcare
service is required to do more and more treatments with less and less
resources, even though we're currently thought to be spending in excess of
£100bn a year (£100,000,000,000) looking after people's physical and mental
health. And as has been pointed out on numerous occasions, it's because we're
all in better physical health, with fewer deadly communicable diseases, better
diets and increased access to regular medicines, our bodies are lasting longer
than they have ever done before, which should be a reason for celebration.
Unfortunately, the down side to this glorious state of affairs would appear to
be a rapid escalation in the numbers of age related degenerative diseases, such
as Dementia, Alzheimer's, Osteoarthritis,
Osteoporosis, Cardiovascular Disease and Diabetes affecting increasing numbers
of our citizens; and all of which are not only long-term conditions, but are
extremely expensive to manage and treat.
In reality of course, these are
not the sorts of long-term degenerative diseases that the private healthcare
providers would willingly choose to treat, as they tend to be expensive to
manage and thus impact negatively on the bottom line of any commercial profit
based company. In order for them to make such patients economically viable in
the long run, either individual healthcare premiums would have to be
extortionately high, or companies would be forced to cherry-pick patients who
were less likely to suffer from such ongoing expensive conditions.
Less than 7% of the UK
population, around 4 million people actually use private medical insurance and
most of those only do so because it forms part of their basic employment
packages, so in some way only reflects an added benefit, rather than being a conscious
decision by the employee to sign up to it. In fact, rather than private health
insurance being a growing market for commercial medical companies, most of the
evidence would appear to indicate that the popularity of private healthcare is
falling within the UK, instead of increasing. But then, why would people choose
to incur the additional cost of private medical insurance, when they already
contribute to a compulsory NHS, which is funded through their taxes? The
obvious answer is, that they probably wouldn't and almost certainly don't!
Where Nigel Farage is probably
right, is in his assertion that sometime in the future, we're going to have to
have a national conversation about our free-at-the-point-of-delivery National
Health Service, about how much it costs us, how exactly we fund it, what part
private healthcare will play in it, what specific treatments it will offer and
even perhaps what our own expectations should be from the NHS. All too often
nowadays there seems to be a commonly held view that hospitals should be
regarded as publicly funded hotels, where malingerers can stay for a much
deserved break, where troublesome and expensive to treat old people can be
parked by their relatives, where the purposely obese can go for some taxpayer
funded weight loss treatment, or where alcoholics can go for a period of drying
out and detoxification. That was never the purpose of the NHS when it was first
founded all those years ago, although successive Labour and Conservative
governments, plus a growing sense of public entitlement have helped to ensure
that what began as a basic health service has been morphed into a "I don't
have to take any personal responsibility" service, which in the long-term
is simply unsustainable.
It simply isn't a solution for the
traditional legacy parties to try and out-bid one another with promises of
bigger and bigger healthcare budgets, or to try and out-reorganise one another
in the way that the NHS is actually structured. More fundamentally, what ALL
political parties should be doing is to take the NHS out of the political arena
entirely; and find the answers to two basic questions, what services should a
National Health Service offer to the people of the UK and how should they be
paid for? Clearly these are complicated issues, but until politicians of all
parties agree to sit down together and find acceptable and realistic answers to
those two big questions, then it's unlikely that the future of the NHS will
ever be truly secured.
If certain individuals are
willing and able to pay for an enhanced NHS experience, would that be wrong,
especially if those extra revenues were being used to improve the NHS
generally? Should sometimes selfish and conniving relatives be able to have a
veto on elderly patients being returned to their homes, causing them to block
valuable hospital beds? Should the state be held responsible for the health of
those who choose to overeat, drink too much, smoke, or do drugs? Is body
augmentation surgery really a valuable use of public money, just because an
individual wants a different nose, bigger breasts, or believes that they were
born in the wrong sort of body? Can we really afford to allow health tourists
from foreign states to use up our limited healthcare resources when they have
paid nothing into the system, when those who have contributed for years have to
wait, or go without? These are just some of the sorts of questions all of our
elected representatives should be asking, rather than trying to outdo one
another over the size of the healthcare budgets, for entirely party political
ends.
Although I think that Nigel
Farage is right, in that the country will undoubtedly need to have that
national conversation about the future of healthcare and the NHS in the years
to come, I fundamentally disagree with him in his view that private medical
insurance is the only obvious answer to the problems that we face. That is not
to say though that if Mr Farage is willing and able to pay for his own private
healthcare then he shouldn't be able to do it, as he obviously can at the
moment, but wouldn't it be much better if he could do that; and the wider NHS
get the benefit of his money too?
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