Branwen Jeffeys looks at some of the key dilemmas facing the NHS.
Programme 4
Tuesday 29 July 2008
Who pays? The Financial Future of the NHS.
The idea of a health service free to all at the point of delivery, paid for out of general taxation has been the cornerstone of the NHS for 60 years.
We're spending more than ever before but the expectations of healthcare and the costs of providing it are continually rising. Can these be met out of taxation, or will patients who can afford it increasingly top-up their care?
Should the NHS give in to the advocates of co-funding - where a patient can combine NHS treatment with paying themselves for an expensive cancer drug which might buy a few months of extra life? Would this, as some argue, undermine the NHS as we know it - leading to a system which favours the rich?
How much longer can the founding principles of the NHS remain intact?
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Have your say
Who pays? How much longer can the founding principles of the NHS remain intact?
Please state clearly if you wish to remain anonymous as your message may be read out on air or published electronically.
Harold Norcross In the discussion on the National Health Service , noone mentioned the iniquitous Government imposition of taxing all insurance premiums, including those for private health insurance, at 5% . A penalty on all those attempting to help themselves . Were those participating in the debate so well off that they can ignore little extras like that ?
Marilyn in Edinburgh The programme was too English-centric. Some of the approaches to dealing with key issues are different in Scotland eg Scottish medicines agency is quicker and more efficient than NICE. The NHS might learn from that?
Dr MI Heatley Dentists were once on the NHS but no longer, We have to go privately in most cases because of the expense we delay until we are worse. This could happen with medical complaints we have to pay for,. until we become too ill for treatment to be effective , Government does not really value theNHS. It sets up private units which cherrypick cases, treating only the simple ones with a quick throughput to maximise profit. It must be assumed that government wishes to please private companies who will keep it in power. Our government seems more influenced by such companies than by the trade unions. Companies seek to make profits by cutting staff numbers and salaries which the unions fight to maintain.
Joe , Glasgow The NHS is easily affoardable if we reduce this capitalist culture and bring these huge drug companies into public ownership. It is totally immoral that human beings can profit to the tune of billions of pounds off the backs of the old, sick and infirm. Everybody pays lip service to a caring society, when in fact most of the welfare state has been privatised. The only parts not privatised is the paying of wages etc.Expences are always covered by the tax payer. The profits go to individual investors.
Dr Lesley Evans, Porlock I am a retired Consultant Geriatrician and in my job I saw very real poverty amongst the elderly, who are so frail and vulnerable, especially when they are ill. My father worked as a GP in London before and in the NHS, and would never have gone back to the days when people wouldn't call him because they couldn't afford to pay, and sometimes died as a result. Neither he nor I ever took private patients as we felt that the best should be available to all, regardless of ability to pay. I do agree that the administration needs to be far more efficient, and I agree with Dr Sikora that it is appalling that the same old fashioned hospital notes seem to go on for ever!! The system should have been fully computerised by now, surely! But we must NEVER go the way of the USA. They have been shown recently to rank last among 19 industrialised countries across a range of health care indicators, the worst of which was access to care, despite the fact that they spend twice as much on health as most other countries. See www.commonwealthfund.org. This report concludes that much of the problem was due to having a weak base of primary care doctors. We need to stop reorganising the NHS and demoralising its well motivated and dedicated workforce, and instead put far more emphasis on good general practice, which is the front line and needs to be strong. Professionalism and a clinically led service is the key.
Rob Denison,Newcastle Upon Tyne If the cost of life saving drugs is only 1% of the total NHS Budget, surely that can be paid for and absorbed by taxation. If there is taxpayers' money to bail out irresponsible banks and building societies,as the financial services bosses are now asking for, the money must be there.The NHS should be kept- and improved!
To increase revenue people over 60 who are in receipt of a reasonable pension could be asked to pay for prescriptions. People should be allowed to 'top up' for drugs when they might otherwise die and still receive NHS care.
Adrianna King-Hall,MPH(Yale) Consultant in Wholis It all depends on what we mean by 'health'. At present we have a service focussed on dis-ease - and medical responses to this. There needs to be a serious discussion focussed on what is the nature of health, if the name of the existing service is to be retained. Without clarity of purpose there can not be well founded decisions on the best use of resources and eventual outcomes.
Bob Franks, in Wales The NHS is more than happy to receive "Top Up Payments" when it's dealing with patients who are injured in road accidents where the NHS will take the car insurance details so that it can claim the cost of treatment from the Motor Insurance companies, so why can't the NHS use the same principle and allow patients to "Top Up" if they are able to, need to or want to depending upon the particular situation. This could go towards overcoming some of the bureaucratic stupidity many patients find themselves in now, at a time when they are most ill or vulnerable.
Alys Woolley, Warwish NHS must be publicly funded but costs of administration must be reviewed. Why must each and every Trust provide all services, IT, HR, wages, etc.etc. Why not set up groups to be covered by one or other Trust running one or other admin. service.
Anonymous Having reached the age of 60, and still in paid employment, I was surprised to find that I was no longer required to pay NI or prescription charges. I feel that I am somehow "cheating" the system.
Laing Donaldson, UK Re NHS funding: as I see it, we want Scandinavian level services but we are unwilling to pay Scandinavian level taxes.
Anonymous I agree with the comment that IT within NHS needs to be improved. On Sunday evening my husband and I visited A&E at Kent & Sussex hospital with multiple wasp stings and swollen lip and eye. There was one receptionist only answering three telephones and recording details of the six injury cases queuing at the desk. Although we both had our NI numbers, she said the computer would not be able to find us from our NI number. She asked for our name, address and date of birth, each time having to ask us to repeat spelling and numbers as she was finding it difficult to concentrate whilst she answered the phones. There was no automatic address software which verifies address from postcode, which all businesses have today. We found all this time-wasting very alarming as the queue built up. However, once through reception, we could not have been given better care and treatment.
Ray Allen, Bexleyheath, Kent Every day,tens of thousands of people take drugs not approved by NICE or any other public body (cigarettes, alcohol and all combinations of hard and soft drugs). Every day GPs, A&E services and almost every branch of medicine spend Millions on care and treatment of these individuals with very little return in terms of 'Health value' or of improvements in Public/Social behaviour. Surely 'co' - charging these individuals for their self indulgences is fairer than a PCT postcode Judgement of Soloman on the seriously ill.
Bob Smith, Bedfordshire The answer to the funding crisis is that elective (planned) medicine/surgery should be means tested. Acute services, such as emergencies should continue to be free for all.
betsy, Berwick upon Tweed In all these debates, I keep saying Look to America. There are 15 MILLION people who cannot afford health insurance and who suffer greatly from lack of medical attention. I grew up there, I have family there. My Dad burnt himself at work and could not work for nearly a year....he had not been able to pay enough insurance, and we suffered and he did because of that. The Doctor's bill was an ongoing worry, and we often were not seen when we should have been as children due to the cost. More recently, my sister who was in an erratic job paid very little health insurance, and went for 3 years with a debilitating stomach complaint. It was only when a brother paid for her to see the doctor that it was discovered she had a parasite, and trichinosis. She has been counting the days till she is 65 because there is a bit more care for people then...at this point. The NHS can be funded by increasing payments for more well off people, by continuing to collect health insurance from those who have reached retirement age but continue to work in well paid jobs, by negotiating with those rather well paid doctors to perhaps accept a bit less. But we need the health service. Socialised medicine is the sign of a civilised society.
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Please state clearly if you wish to remain anonymous as your message may be read out on air or published electronically.
Harold Norcross
In the discussion on the National Health Service , noone mentioned the iniquitous Government imposition of taxing all insurance premiums, including those for private health insurance, at 5% . A penalty on all those attempting to help themselves . Were those participating in the debate so well off that they can ignore little extras like that ?
Marilyn in Edinburgh
The programme was too English-centric. Some of the approaches to dealing with key issues are different in Scotland eg Scottish medicines agency is quicker and more efficient than NICE. The NHS might learn from that?
Dr MI Heatley
Dentists were once on the NHS but no longer, We have to go privately in most cases because of the expense we delay until we are worse. This could happen with medical complaints we have to pay for,. until we become too ill for treatment to be effective , Government does not really value theNHS. It sets up private units which cherrypick cases, treating only the simple ones with a quick throughput to maximise profit. It must be assumed that government wishes to please private companies who will keep it in power. Our government seems more influenced by such companies than by the trade unions. Companies seek to make profits by cutting staff numbers and salaries which the unions fight to maintain.
Joe , Glasgow
The NHS is easily affoardable if we reduce this capitalist culture and bring these huge drug companies into public ownership. It is totally immoral that human beings can profit to the tune of billions of pounds off the backs of the old, sick and infirm. Everybody pays lip service to a caring society, when in fact most of the welfare state has been privatised. The only parts not privatised is the paying of wages etc.Expences are always covered by the tax payer. The profits go to individual investors.
Dr Lesley Evans, Porlock
I am a retired Consultant Geriatrician and in my job I saw very real poverty amongst the elderly, who are so frail and vulnerable, especially when they are ill. My father worked as a GP in London before and in the NHS, and would never have gone back to the days when people wouldn't call him because they couldn't afford to pay, and sometimes died as a result. Neither he nor I ever took private patients as we felt that the best should be available to all, regardless of ability to pay. I do agree that the administration needs to be far more efficient, and I agree with Dr Sikora that it is appalling that the same old fashioned hospital notes seem to go on for ever!! The system should have been fully computerised by now, surely! But we must NEVER go the way of the USA. They have been shown recently to rank last among 19 industrialised countries across a range of health care indicators, the worst of which was access to care, despite the fact that they spend twice as much on health as most other countries. See www.commonwealthfund.org. This report concludes that much of the problem was due to having a weak base of primary care doctors. We need to stop reorganising the NHS and demoralising its well motivated and dedicated workforce, and instead put far more emphasis on good general practice, which is the front line and needs to be strong. Professionalism and a clinically led service is the key.
Rob Denison,Newcastle Upon Tyne
If the cost of life saving drugs is only 1% of the total NHS Budget, surely that can be paid for and absorbed by taxation. If there is taxpayers' money to bail out irresponsible banks and building societies,as the financial services bosses are now asking for, the money must be there.The NHS should be kept- and improved!
To increase revenue people over 60 who are in receipt of a reasonable pension could be asked to pay for prescriptions. People should be allowed to 'top up' for drugs when they might otherwise die and still receive NHS care.
Adrianna King-Hall,MPH(Yale) Consultant in Wholis
It all depends on what we mean by 'health'. At present we have a service focussed on dis-ease - and medical responses to this. There needs to be a serious discussion focussed on what is the nature of health, if the name of the existing service is to be retained. Without clarity of purpose there can not be well founded decisions on the best use of resources and eventual outcomes.
Bob Franks, in Wales
The NHS is more than happy to receive "Top Up Payments" when it's dealing with patients who are injured in road accidents where the NHS will take the car insurance details so that it can claim the cost of treatment from the Motor Insurance companies, so why can't the NHS use the same principle and allow patients to "Top Up" if they are able to, need to or want to depending upon the particular situation. This could go towards overcoming some of the bureaucratic stupidity many patients find themselves in now, at a time when they are most ill or vulnerable.
Alys Woolley, Warwish
NHS must be publicly funded but costs of administration must be reviewed. Why must each and every Trust provide all services, IT, HR, wages, etc.etc. Why not set up groups to be covered by one or other Trust running one or other admin. service.
Anonymous
Having reached the age of 60, and still in paid employment, I was surprised to find that I was no longer required to pay NI or prescription charges. I feel that I am somehow "cheating" the system.
Laing Donaldson, UK
Re NHS funding: as I see it, we want Scandinavian level services but we are unwilling to pay Scandinavian level taxes.
Anonymous
I agree with the comment that IT within NHS needs to be improved. On Sunday evening my husband and I visited A&E at Kent & Sussex hospital with multiple wasp stings and swollen lip and eye. There was one receptionist only answering three telephones and recording details of the six injury cases queuing at the desk. Although we both had our NI numbers, she said the computer would not be able to find us from our NI number. She asked for our name, address and date of birth, each time having to ask us to repeat spelling and numbers as she was finding it difficult to concentrate whilst she answered the phones. There was no automatic address software which verifies address from postcode, which all businesses have today. We found all this time-wasting very alarming as the queue built up. However, once through reception, we could not have been given better care and treatment.
Ray Allen, Bexleyheath, Kent
Every day,tens of thousands of people take drugs not approved by NICE or any other public body (cigarettes, alcohol and all combinations of hard and soft drugs). Every day GPs, A&E services and almost every branch of medicine spend Millions on care and treatment of these individuals with very little return in terms of 'Health value' or of improvements in Public/Social behaviour. Surely 'co' - charging these individuals for their self indulgences is fairer than a PCT postcode Judgement of Soloman on the seriously ill.
Bob Smith, Bedfordshire
The answer to the funding crisis is that elective (planned) medicine/surgery should be means tested. Acute services, such as emergencies should continue to be free for all.
betsy, Berwick upon Tweed
In all these debates, I keep saying Look to America. There are 15 MILLION people who cannot afford health insurance and who suffer greatly from lack of medical attention. I grew up there, I have family there. My Dad burnt himself at work and could not work for nearly a year....he had not been able to pay enough insurance, and we suffered and he did because of that. The Doctor's bill was an ongoing worry, and we often were not seen when we should have been as children due to the cost. More recently, my sister who was in an erratic job paid very little health insurance, and went for 3 years with a debilitating stomach complaint. It was only when a brother paid for her to see the doctor that it was discovered she had a parasite, and trichinosis. She has been counting the days till she is 65 because there is a bit more care for people then...at this point. The NHS can be funded by increasing payments for more well off people, by continuing to collect health insurance from those who have reached retirement age but continue to work in well paid jobs, by negotiating with those rather well paid doctors to perhaps accept a bit less. But we need the health service. Socialised medicine is the sign of a civilised society.