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Why we HAVE to start thinking about the future of the NHS, writes PROFESSOR STEPHEN SMITH 

We need to talk about ‘our’ NHS. It is quite clear that it is at a breaking point and that radical reforms are needed to ensure its survival. And yet anyone who dares to say so risks hysteria.

Hospitals in England are massively understaffed. A report from the Commons Health and Social Care Committee this week found that we need an additional 12,000 doctors and more than 50,000 nurses and midwives.

By the early 2030s, the NHS is expected to require an additional 475,000 workers, with a further 490,000 jobs for carers.

But these services are already under heavy pressure. Last year, one in three caregivers retired and the number of full-time GPs has fallen by more than 700 since 2019, the majority of whom are now only working part-time. The average waiting time for an ambulance is no less than 51 minutes.

'Hospitals in England are hopelessly understaffed.  A report this week from the Commons Health and Social Care Committee found that we need an additional 12,000 doctors and more than 50,000 nurses and midwives.

‘Hospitals in England are hopelessly understaffed. A report this week from the Commons Health and Social Care Committee found that we need an additional 12,000 doctors and more than 50,000 nurses and midwives.

Yesterday’s post contained the horrifying story of a 61-year-old heart patient, herself a retired GP, whose husband drove her 300 miles from Cornwall to London after experiencing chest pains in search of a hospital bed.

Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College

Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College

Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College

outrage

We just can’t go on like this. In the wake of the pandemic and its impact on healthcare, Britain has a record 6.6 million people on NHS waiting lists – and that number is rising. It is unsustainable and we must address it.

But how? It is, of course, extremely useless that any attempt at dialogue about the future of the NHS should be greeted with outrage and panic by those who believe it to be blasphemy, even to consider alternative ways of financing the system.

These people claim to defend ‘our NHS’ by refusing to accept change and instead insisting that any problem can be solved with ‘more money’. But perhaps, ironically, they could limit our health system to death with that requirement

If only we could have an open discussion about the alternatives out there, people might realize that the status quo might not be the best option. There are several internationally recognized alternatives that can help us. One – which I’ve addressed in a new book published this week by think tank Radix UK – could be ‘hotel costs’ for hospital admissions, as in the German and French models, where patients receive a nominal fee (around £8 per night) pay for a bed.

I advocated this not as a policy per se, but as one of many options that we can consider as a starting point for discussion. Yet it was greeted with outrage in some circles. Somehow it is considered almost unpatriotic to point out that many developed countries have health services that are superior to ours in some ways: more efficient, shorter waiting lists, more beds, better outcomes for cancer and other diseases.

'By the early 2030s, the NHS is expected to need 475,000 additional workers, with a further 490,000 jobs for carers'

'By the early 2030s, the NHS is expected to need 475,000 additional workers, with a further 490,000 jobs for carers'

‘By the early 2030s, the NHS is expected to need 475,000 additional workers, with a further 490,000 jobs for carers’

But we have to face the facts. The NHS is almost 75 years old. In all that time it has been centrally funded through taxes and no matter how much money is put into the service, it is never enough.

Every other aspect of life in Britain has changed radically in these more than seven decades. It makes no sense for us to continue with an elderly health care, wheezing on life support.

However, let me make one thing clear: No matter what new funding models we incorporate, we can never adopt the US system of individual health insurance policies that price out those with lower incomes. No country should suffer from that. It is also true that there is no perfect health care system anywhere in the world. They all have pros and cons.

A simple method would be to have a hypothetical tax levied to raise money specifically for the NHS.

This is what Jeremy Hunt considered when he was health minister, and proposed a ten-year financing plan with tax increases targeting older workers.

Another idea was to make the 1.2 million pensioners who continue to work after retirement age pay national insurance. Both schemes would be very unpopular with people who have already paid taxes all their working lives, as would the suggestion to scrap universal free prescriptions for people over 60.

The chart shows the NHS England's waiting list for routine surgeries, such as hip and knee surgeries (red line), which reached a record high of 6.18 million in February this year.

The chart shows the NHS England's waiting list for routine surgeries, such as hip and knee surgeries (red line), which reached a record high of 6.18 million in February this year.

The chart shows the NHS England’s waiting list for routine surgeries, such as hip and knee surgeries (red line), which reached a record high of 6.18 million in February this year.

In April of this year, all employees started paying the 1.25 percent increase in NI payments, the Health and Social Care Levy, to help manage our social care crisis. But such money has never been delineated, and it is said that for this year it will go towards clearing the Covid-related backlog. How likely it is that that money will ever find its way into social care is a mystery.

Indeed, the real problem with earmarking specific taxes is that governments will always be tempted to loot them for other, more immediate purposes.

We have to be more inventive. We are an endlessly resourceful and innovative country. It must not go beyond our collective powers to improve the NHS.

For example, we could increase the number of additional costs, such as the costs we already pay for prescriptions and dentistry.

These allowances can subsequently become means-tested and reimbursed to people with a lower income. And elderly or long-term patients can also be excluded, so that any additional costs are only borne by those who can actually afford it.

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I think this would be much more popular than a general tax increase. And, crucially, we know it could work, because it’s already common in Europe.

Figures show how NHS bed occupancy shifted during the pandemic

Figures show how NHS bed occupancy shifted during the pandemic

Figures show how NHS bed occupancy shifted during the pandemic

The French pay a similar rate to see a GP. This discourages time wasters with frivolous complaints, reduces the pressure on doctors and frees up more appointments. And of course the fee is refunded for those who can afford it less.

I would expect up to 90 percent of patients to be reimbursed, just as only about 10 percent of people in England who pick up a prescription actually have to pay. The vast majority are exempt.

A counter-argument sometimes made is that successful cancer treatment often relies on early diagnosis, and anything — like a prepayment to see a doctor — that makes people less likely to get tested is dangerous. But the numbers also show that cancer outcomes in France are actually better than in Britain.

The French and Germans also have a much better level of acute hospital beds than we do. But the Scandinavian countries don’t – and their health care is often considered the best in the world.

Sweden and other Scandinavian countries have excellent social care services that allow them to avoid many problems before hospitalization is necessary. But everything has a price tag and the Scandinavians pay much higher taxes than we do

inhuman

At the height of the pandemic, Britain finally seemed to recognize one crucial factor: the role of our excellent medical staff. Doctors, nurses and other caregivers perform some of the most difficult tasks imaginable. It makes sense to reduce the tension and pressure of their lives whenever possible.

If we don’t, many will stop from exhaustion or disillusionment – as they already do. The treadmill for GPs, which is expected to do a consultation every eight minutes, hour after hour, is inhumane. It takes up to 15 years to train a doctor. Anyone leaving the NHS is a serious loss.

We cannot keep shouting ‘I love the NHS’ and hope that only love will make it. This week’s cross-party report is a step forward. But it must lead to an emotionless, honest debate about the future if it is to have any real effect.

People can disagree and fight for what they think is the best way. After all, there is no single answer to the crisis in the NHS. But one thing is certain: the system breaks and blindly throwing money at it won’t solve it.

  • Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College.

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