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by Trevor Gay, Simplicity Is The Key Ltd.
 As in the United States, the
topic of healthcare is much discussed in the United Kingdom,
where the internationally admired British National Health
Service is a political hot potato, and British politicians
that tamper with it do so at their peril. In our
continuing coverage of healthcare around the world, we take a
closer look at what is happening in the U.K. Author Trevor Gay
worked for thirty five years in the National Health Service.
As he states, the views expressed in this article are
personal, subjective, anecdotal, and narrative, rather than
objective, rational, academic, or on behalf of
anyone.
The British National Health Service (NHS) is often referred
to affectionately as a “sacred cow,” given both its
distinguished history and the considerable affection invested
in it by the British people.
Recently, however, there has been mounting consumer and
political pressure in Britain to consider expansion of the
private healthcare sector in Britain, which would in turn
undermine the core principles of the much-loved NHS. Some
critics believe this would result in the NHS becoming a dead
cow rather than a “sacred” one.
This presents a fascinating challenge for the British
government, and one that is only going to grow in complexity
and importance in the coming decades.
The Facts
1.The NHS is the third largest employer in the world after the Chinese Army and the Indian Railways.
2.The NHS employs 1.4 million people.
3. The annual NHS expenditure for 2007/08 will be over $177 billion.
4. The NHS is a government-run service and is funded primarily from taxation.
5. The service is available free of charge at the point of delivery and based on clinical need to the entire British population—approximately 60.5 million people
6. Over recent years funding has increased to record levels. Since Tony Blair and the Labour Party came to power in 1997, the NHS budget has doubled, and by 2008 it will have trebled.
The annual 7.4% budget increases started after Tony Blair promised in 2000 to bring health spending as a proportion of GDP up to European levels. At the time 6.8% of GDP was spent on health, compared to 8% across the continent.
The government is currently on target to hit 9% of GDP when the record increases come to an end in 2008. When spending reaches that level, it will bring Britain closer to the top of the European health-spending league dominated by Germany and France.
The NHS story so far …
To understand current attitudes to the NHS among British people we first have to look back some sixty years. The NHS was created by the government in 1948 as a State-funded, free-at-the-point-of-delivery service for every member of the British population. It was introduced by a socialist government elected at the end of the Second World War (1939-45).
The population was promised by politicians of the day that in respect of healthcare: “No longer will wealth be an advantage nor poverty a disadvantage.”
For the last sixty years the NHS has remained both the best loved and yet the most castigated public service in Britain. For this reason it is generally considered political suicide for any politician to suggest reform of the NHS by changing it to a private service.
The NHS--sacred cow or dead cow?
I personally feel the NHS is neither.
Although the NHS is highly regarded by most people using it, the patient in the modern healthcare setting is changing. This new patient has more information and therefore demands higher standards. No longer are patients passive and grateful recipients of healthcare. They are well-informed customers who rightly demand information about what is happening to them. When they hand over the care of their body to a healthcare professional they are literally placing their lives in that professional’s hands. Patients today want an equal partnership with the healthcare professional, not a master/servant relationship.
I am optimistic about the empowered new patient, and I am equally optimistic about how healthcare professionals are responding to this challenge. I believe we can look forward to more equal partnerships as confidence and trust grow on both sides of the relationship.
The NHS is still greatly valued by the majority of people in Britain. I do not believe there is significant support for a switch to a truly private and competitive healthcare marketplace.
Having said that, I sense among the under-40’s more sympathy to the prospect of a mix of private and public healthcare. This might mean more market share than in the past for private healthcare, which would undoubtedly suit the lifestyle of the yuppie in a hurry.
Not only is the NHS a greatly valued institution, but the affection and esteem in which clinical and hospital staff are held by the public is tremendous.
The same cannot be said about managers in the NHS. The image and reputation of these managers is often that of highly paid people who are adding little value to the patient experience. I don’t personally sign on to that sweeping generalisation. In reality the expenditure on management in the NHS is less than in most large organisations. The general perception of NHS management is nevertheless negative.
People who work in the NHS have become accustomed to regular government tampering with the way this gigantic institution is organised and structured. Improvements in patient care go on despite of these changes rather than because of them, in my opinion. There is great loyalty and goodwill among the 1.4 million people who work in the NHS. I believe most of them have a sense of pride that they are contributing to improving the health of our nation.
It is an interesting fact that very few people work in the NHS primarily for financial reward.
Summary
For the foreseeable future, demand for healthcare in the United Kingdom will continue to exceed supply and will rise more steeply with increasing scientific, medical, and technological advances.
The NHS has existed for close to sixty years. It employs around 1.4 million people. Even though I am not a numbers man, this tells me that the NHS probably has something like 60 million years worth of healthcare knowledge to capitalize upon. So let’s not throw the baby out with the bath water. We can learn from the past.
What is needed is a sensible debate about the options Britain will face in the future for the organization and funding of its healthcare. We should not consider this matter from the point of view of whether we need a national service or a private service or a mixture of the two. The public must be presented with the facts about current funding of the NHS and likely future requirements.
In Britain, the biggest thing we have going for us is that we already have a National Health Service. As a result we have a great emotional investment in making sure the focus of our politicians and our leaders remains firmly fixed on healthcare. The NHS can only be changed with the consent of the people, and I hope Britain maintains that democratic position for many years to come as we continue to explore alternative models.
Managing the NHS remains one of the greatest challenges for any aspiring British political leader. Future Secretaries of State for Health will have to grapple with new healthcare options and come to terms with new health challenges. But I suspect pragmatism born of necessity will win the day.
So in my view the NHS cow is certainly not dead—it is not even terminally ill—but it may not be as sacred as it used to be.
About Trevor Gay
I worked in the NHS from the age of sixteen until November 2004 when, at the age of fifty-two and having reached a senior management position, I decided that--as my late beloved Dad would have said--it was time for me to get a real job. I left the comfort blanket of NHS employment and a guaranteed pension to work independently as a healthcare management consultant, coach, trainer, and author. This followed the publication of my first book Simplicity is the Key, published in October 2004. The new world I occupy has its moments. Sometimes I worry about how I am going to eat next month, but then I remember that life is more than money. My wife Annie is my inspiration and always reminds me of what is really important.
Simplicity Web Site: www.simplicityisthekey.com/
Simplicity Blog: http://www.simplicityitk.blogspot.com/
If you have any comments or questions about this article, email trevor.simplicity@gmail.com. |
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