The Labour Government has had some success with the NHS since taking power in 2024 and, it seems, funding 5 million extra health appointments. But valid questions remain over the structure of this core element of Britain’s welfare state. Here are the bullet points of our debate:
1: A proposal that the NHS and Social Care should be funded and organised as a single system. This could reduce the blocking of around a third of hospital beds by mainly elderly, vulnerable patients with nowhere safe to go.
This would be the biggest single way to reduce waiting lists for operations. It would also end the legal battles between the NHS and local authorities over who should pay the bills in care homes. But it could be very, very expensive!
2: There should be an independent board of experts to run the NHS – at arm’s length from politicians. This would stop it being used as a political football, resulting in crude reorganisations to gain headlines.
More continuity and fine-tuning of policy should lead to better outcomes. But our first past the post, adversarial politics makes it difficult to achieve consensus on long-term policies.
3: Our health system is underfunded compared to most of our counterparts. UK: Second lowest of G7 countries. Highest France and Germany. As a percentage of GDP, UK healthcare spending fell from 9.8% in 2013 to 9.6% in 2017, while healthcare spending as a percentage of GDP rose for four of the remaining six G7 countries.
SO! To provide more resources for the NHS – Beds, Doctors, Nurses etc – would it be a good idea to follow France and Germany for example in having an element of private insurance?
This was highly controversial in our group. There was a suggestion that systems with an element of private insurance might allow wealthier citizens to be treated in the hospital of their choice or by the doctor of their choice, maybe in a private room. Would this matter if there were more beds, doctors and nurses available for everyone?
4: There should be No Fault compensation settlements for all medical negligence claims – based simply on the need of claimant. This would end very expensive legal contests and some exorbitantly high settlements.
Clinical negligence is a huge industry in the UK. In 2020: it cost £2.6bn out of the NHS budget of £129bn. 10% of claims in obstetrics account for 50% of compensation spend. Every baby born in the NHS in England now incurs indemnity costs of £1100.
The other main benefit is that it should encourage full disclosure of what has gone wrong and a much greater ability to correct dangerous practices. It’s what the airlines do.
5: There is a perceived tyranny over doctors by some not very good hospital managers. NHS managers should to have qualify and belong to a professional body that could strike them off. So they couldn’t just move on after a major failure. The senior managers should be drawn more from medically trained staff.
There was a sense that there was sometimes a war between accountants and medical practitioners. Also that sometimes managers would be too driven to fulfil political targets, even if they were medically dangerous.
6: Small, means tested charges should be introduced for visiting a GP or non-urgent visit to A&E for example. This would make people think about the urgency of their need for a medical visit and could limit the relentless flow of demand. It might make patients less likely to miss appointments. The poorest people would not have to pay.
Highly controversial!
HOW WE VOTED
Q1: 6 YES
Q2: 6 YES
Q3: 3 YES, 2 N/A, 1 NO
Q4: 5 YES, 1 NO
Q5: 6 YES
Q6: 2 YES, 4 N/A
(The N/A category meant that people couldn’t decide or else thought the question was over-simplified.)
Now please have your say. Post comments below:
It seems to me reasonable to ask patients and residents in care homes to make a contribution towards their ‘hotel’ costs which could be covered by a private insurance. This would make points 1 and 3 more affordable depending on the level of contribution.