Caring for our nation’s health

Our heath system is modelled on the British National Health Service – a service that, up to some years ago, was considered as one of the best symbols of the welfare state. Pressures are now building up in the NHS as a result of years of neglect of the financial fundamentals that must underpin an effective medical service. Our own health service is facing similar pressures, even if few politicians admit this publicly.

The Liberal-Conservative government in the UK has defined major radical reforms for the NHS very early in the life of the new administration. Their ultimate aim is to achieve £20 billion in “efficiency savings”, mainly by opening up the provision of medical services to competition and cutting layers of middle management.

In 2006 David Cameron pledged that “The NHS is safe in my hands”, knowing well that the British electorate treasured the services of the NHS and was not prepared to elect anyone who threatened to reduce them or charge for them.

The symptoms of a funding crisis are there for all to see: growing waiting lists, rationed treatment, insufficient preventive medical schemes, and artificial shortages of ‘free’ medicines for those who need them most. Does anyone doubt whether the same symptoms are being experienced in our own health system?

British politicians have not dared suggest that if the public wants a better health service they need to be prepared to pay for it. Such a declaration would almost certainly have amounted to political suicide. The electorate would probably banish to the benches of the opposition anyone bold enough to suggest that at least some health services should be partly financed directly by consumers.

The expectation of most European citizens that health services should continue to be free at the point of service is a legitimate one. The free health service provided in countries like the UK, France and Germany is one of the privileges of living in Europe rather than in the US where until recently over 60 million people were not even insured against the costs of getting basic medical care.

But all public services come at a cost. Balancing the books of the NHS in the UK, as is the case with our own health system, is proving to be a formidable task. Public finances are undoubtedly in bad shape in the UK and public expenditure and benefit cuts are afflicting the prosperity of most families. So, increasing taxation at this stage to balance the books of the NHS is not really an option – certainly not after the major political parties often repeated mantra that the NHS should remain free for all British citizens.

But reducing the level of health service through stealth is not an option the British public is prepared to accept. No one could argue against the wisdom of improving efficiency through better management of the health service. However, there is a limit as to what such improved efficiency can achieve.

Many rightly argue that any money saved through improved efficiency should in fact be ploughed back into the service in view of the increasing demands on the health system resulting from an increasingly aging population, the higher cost of necessary modern medical technology, and the legitimate expectations of the public for a more efficient medical service.

At least in the UK the debate on the future of the NHS has started in earnest. The frustration and anger of medical and paramedical staff organisations is helping to introduce a sense of urgency and momentum for the government to tackle the underlying weaknesses of the NHS. Short, sharp shocks to the health system are probably not the best way forward, even if this strategy is preferred by a newly elected government that can blame all the ills of the system on the previous administration.

The UK government may, after all, abort the still unborn reforms. Prof. Martin Rowland from Cambridge University, writing in the New England Journal of Medicine, said: “Any benefits from the reforms could take seven to 10 years. And history suggests that governments do not have the patience, nerve or opportunity to see things through the disruption.”

So, pressures continue to build up in the NHS, as they are in our own health system, except that our debate on how we should resolve the conundrum of how to provide a free and effective health system has not even started. This needs to change, if we really care about our nation’s health.

jcassarwhite@yahoo.com