HEALTH spending in England during the financial year 2018/19 was approximately £129billion, and is expected to rise to nearly £134billion by 2020. Of that, £115billion was spent on the NHS England budget, while the rest was spent by the Department of Health on initiatives, training, education and infrastructure, which includes IT and new hospitals.
In spite of that massive budget, the NHS operates under severe financial pressures. Trusts across England collectively ended up in 2018/2019 with a deficit of £571million – not a huge percentage of the total perhaps, but still an enormous amount over-spent. There is political pressure for savings, at the same time as demand is rising and the population is ageing. Some claim that treatments are being rationed, while patient care is often found to be inadequate.
It’s all looking a bit of a mess. Why? It seems to me to be the result of a gap between the political scope of the health care system and how the government is managing to finance it. Techniques and medication have developed greatly in the 71 years since the NHS was initiated. But so has the range of ‘health’ issues which the national service sees the need to treat at taxpayers’ expense. Cosmetic procedures, sex transitioning even for infants, fertility for ageing would-be parents as well as the growing costs of obesity: all would have William Beveridge turning in his grave. Then there’s ‘mental health’ – the whole nation appears to be suffering a serious nervous breakdown.
This is happening everywhere in the developed world, but one of the solvable issues in the UK is that even when the authorities have decided what the service ought to be treating, there is no consideration of either its affordability, access or even rationing. The holy cow of ‘free at the point of access’ means ‘very expensive at the point of taxation’.
It’s not for nothing that the design of the NHS is not replicated anywhere else in the world. Health care is the greediest money-eating aspect of western societies. The amount the UK spends on it should have the world salivating with envy. Instead they see an example of poor value for money.
Let me tell you about health care where I live in Eastern Switzerland. Everybody moans – the insurance premiums keep going up, and you always seem to get less cover. But health care here is superb. And everybody knows exactly what it costs, because they receive itemised statements from their insurance company. The cost of your blood pressure meds, the cost of 15 minutes with your GP, and if you’re really unlucky the cost of calling an emergency ambulance (which will turn up in five minutes, superbly equipped and manned, and will probably cost you over £1,000, because your insurance doesn’t cover it). It all makes people think, and even take care.
National Insurance taxation was supposed to pay for universal health care in the UK. But it’s not ring-fenced, and all costs now come out of general taxation, which is paid by only about 50 per cent of the UK population. All of this half of the population have the legal right of access, but far more worrying is the fact that the NHS has no mechanism for restricting access to its enormously expensive care system to those who are absolutely not entitled to it, namely health tourists who have left £150million of unpaid bills. Nigel Farage was vilified for saying that non-contributors came to the UK to get free HIV treatment. The Sun retells here the story of a Nigerian woman who came to the UK to deliver her IVF quads, two of whom died, and she left an unpaid bill of nearly half a million pounds. Why would any taxpayer-funded organisation even contemplate this?
The Left will tell you that it’s because we are a rich country and we can afford it. The country I live in is also relatively rich, but wouldn’t put up with this for two seconds. When we moved here, we applied for the right to reside. No problem at all – except we would need personal medical insurance. Without that, the young man at the Rathaus said ‘we could become a burden on the community’. So we sorted it out. Amazingly, just a few months before, the UK and Switzerland had made a bilateral agreement whereby retired UK citizens in Switzerland and Swiss citizens in the UK would be afforded reciprocal health insurance.
This means that we can access Swiss-quality health care, paid for in part by the NHS. Everyone here has to pay upfront the first CHF 400 (£328) of health care costs per annum, and thereafter approximately 10 per cent of charges. I believe this discourages unnecessary calls on GPs and demands for medication. But what the NHS partly pays for here is very different from what it pays for in the UK. I have personal experience of both. The London hospital which sorted out my broken leg was superb until it came to the after-care. The ward was not well cleaned, the food was inedible. The woman in the bed opposite had a faithful spouse who brought her three meals a day from McDonald’s. She wouldn’t touch the slimy porridge they were serving up.
Compare that with my hip replacement operation here. The Swiss system is organised largely through subsidiarity, with cantons having financial discretion, and are not pinned down to the outrage of PFI in the UK. You can choose your GP, your surgeon, even the clinic where they treat you. The wards are immaculate, and the food is worthy of a five-star hotel, because the health professionals here know that proper nutrition is a key element in patient recovery.
It doesn’t end there. After a week of care in the clinic, you get a further three weeks of rehabilitation, with physiotherapists, a swimming pool, a fully equipped gym, and all that healthy in-house cooked food. Even visitors, hikers and families came daily to the canteen to eat the same healthy food provided for us. (They pay, of course.) And on being sent back home, three weeks of extra physio, just to make sure.
So why can’t the NHS follow the same rules and procedures in England? It’s not up to doctors or nurses – they are health professionals and care-givers. What the entire system lacks is the right sort of bureaucrats – ordinary secretaries, like the ones here who check my health card and make sure I’m paid into the system before I am treated. It’s not judgmental – it’s a case of knowing the rules and understanding how to enforce them. They are the necessary gatekeepers to control a very expensive system.
So what’s so difficult in the UK? It’s a routine job, especially if you are Swiss, and accept the importance of rules and enforcement. If UK politicians can’t or won’t work that out, I’ll happily volunteer to do it for them. Dead easy.