The NHS should stay free

NHS Funding

The NHS is going through one of the toughest periods of its life.6 Every day we hear of general practices closing,7hospitals at full capacity,8 patients waiting in pain in emergency department corridors, ambulances queuing up with patients outside hospitals, and a social care system cut to the bone.

Politicians, commentators, and think tanks often say that we need a serious conversation about NHS funding.9 This usually means, “Let’s start making patients pay.” And because of the huge pressures the NHS is under some of them think that soon this will happen10: private companies will offer “fee-for-service” appointments or care, and private insurance companies will help write new “NHS policies” to give patients access to their GP or to pay for some operations or procedures.

Any appointments above a threshold, or more complex procedures, would be funded by patients “topping up.” This is common in the United States, which has one of the best healthcare systems—if you can afford it—but also some of the most iniquitous healthcare in the world.

Envy of the world

That is why the model of the NHS from 1948 onwards has been the envy of the world. It is paid for from general taxation, free at the point of use, and available to all no matter what your background, bank balance, or location in the UK.

We must ask why we are in such a dire financial situation when in 2010 the NHS had the highest ever satisfaction rating and shortest ever waiting times.11 Since 2009 funding has increased by just 0.9% on average a year,12 and this is set to continue until 2020. Many economists think that the NHS needs a 3%-4% increase a year just to keep pace with demand.13

This 0.9% increase has allowed governments to say, “We have increased NHS funding year on year,” because inflation has been low.14 However, it does not make up the 3%-4% shortfall and has led to this disastrous financial situation throughout the NHS.

Cuts in funding

An explicit decision was made at the highest political levels to offer the NHS these paltry amounts. The economic policies of the 2010 and 2015 administrations have led to many cuts in funding for public services. The NHS was “protected” but only against inflation. The blame for the current state of the NHS lies firmly at the door of our politicians. This allows talk of “top-up insurance” as the answer to the NHS’s woes.

Having a budget for a package of care, say for one year’s treatment for diabetes, sounds attractive. But what happens when that money runs out? People who could afford it could top this up for extras such as diabetic retinopathy. But people with no insurance or savings would be unable to do this and lose out. We should be working hard to ensure that everyone has equal access to all the care they need.

Politicians could decide to fund the NHS adequately if they were to end their obsession with cutting public services. Governments can borrow at all-time low interest rates, and investment in healthcare has been proved good for the economy.15

Exorbitant interest payments

We should be investing in front line staff instead of “management consultants” of dubious value.16 And we should find a way to end the exorbitant £2bn a year interest payments for private finance initiatives that could be spent on caring for patients.17

Without more money we are just a short step away from the introduction of NHS health insurance or demands that the public supplement out of their own pockets. That would be a sad day for patients, and the NHS as envisaged—free for all at point of need—will be gone.

This article first appeared in the British Medical Journal