The radical online pressure group 38 Degrees are lobbying for an inquiry into the NHS in order to put pressure on the Government to ‘fund hospitals and GP surgeries properly’. It is common knowledge that health costs are rising because of the growing number of elderly, but perhaps the health service does not need more funds? There some areas of care that should be cut.
For example, why should the National Health Service pay for my skiing accident? My badly broken leg was the result of risk taking on the slopes. Surely, I should have insurance that covers dangerous sports? Self-inflicted injuries through recreational activities like riding or skydiving could be covered by insurance, saving money for those who are genuinely sick.
If Deloitte, or KPMG or one of our big British accountancies was running the inquiry into the NHS they would use ‘Priority Based Budgeting’. This is a process which starts with a complete list of services which are then prioritised. The most important services – such as care for sick children, are put at the top, and the least important are at the bottom and removed. Self-inflicted holiday injuries would be at the end of the list, together with injuries caused by drinking or drugs. Holiday insurance provides care for my broken leg; private firms could set up city centre emergency care for drunks and drug addicts. At last our overrun A & E could deal with real accidents.
Deciding that recreation is not part of our health cover would deliver cost reductions. Recreational activities would include sex – why should the NHS provide contraceptive pills so that we can have more fun? The National Institute for Health and Care Excellence would have clearer guidelines – they decide which drugs and treatments are available on the NHS in England and Wales based on what is value for money, and has benefits for patients. They would not be allowed to approve drugs that were recreational. In the case of PrEp, the pill that protects gay men whose partners are HIV positive, their argument would not just be cost (between £10 and £20 million a year) but that the NHS does not pay for pleasure. At the same time we would also say goodbye to cosmetic surgery and penis extensions.
Priority Based Budgeting can go further. The NHS is in urgent need of more money. Chris Hopson, the chief executive of the NHS providers, said on Andrew Marr’s TV programme that ‘something has to give’ and that we ‘couldn’t pretend that gap doesn’t exists’. If Priority Based Budgeting is taken seriously, then a seven-day NHS could be affordable. At present, the NHS provides social care – we could strip anything that is not medical from the service.
In India, the chain of Narayana Hrudayalaya heart surgery clinics reduced the cost of heart surgery to $800 by using pre-fabricated buildings, removing air-conditioning and training the family to help with post-operative care. Their success rate in terms of medical excellence remained high.
We train our doctors and nurses to provide medical not social care. Anything non-medical should be stripped away from the service. That is food, and bedding, and care to be provided by the family, not the health service. What is more, it will help recovery times. Research from the University of Texas Medical Branch at Galveston showed that patients with supportive family and friends spend less time in hospital. Patients with support from family or friends needed less time than predicted by Medicare.
When an NHS operation is scheduled, the patient would need to list the family member or friend who is going to look after them and ensure that they do not block the bed for the next patient. Our health service would remain free at point of use but social care would not be part of it. Before an operation, people with no friends or family would need insurance or social services listed as their care provider while they are in hospital or returning home. Bed blocking would be a problem of the past.
So yes! Let’s have an inquiry into the health service, but make sure it is run by accountants not politicians. Then we can afford a seven-day NHS.