A Labour Government: Reform of the National Health Service?

As long as Scotland is part of the UK...it would be wise for the Scottish government to partner Westminster Labour in examining NHS reform.

Cooperation needed for progress on NHS reform

We are almost certain in the UK to get a Labour government this year, and if Wes Streeting is to be believed there will be yet another attempt to reform the NHS.  Although the Scottish Parliament is responsible for the NHS here, and the structure of the service has been different from that in the rest of the UK right from the start (our teaching hospitals were an integral part of our system unlike n England), the key principles are the same: how it is funded and free at the point of need.  As long as Scotland is part of the UK, with its income from Westminster affected by English NHS and other public expenditure, it would be wise for the Scottish government to partner Westminster Labour in examining reform.

I have always had difficulty in understanding some people, who like me are in favour of independence, see it as a political sin to co-operate with the Westminster government when there are common issues to be addressed, where the “two heads are better than one” idea is best applied. It would not, for example, have compromised the SNP position on independence one iota to engage in an all-UK census. Nor will it be fatal compromise to join the UK government in having an in-depth rigorous examination on what ails the NHS, and how to sort it in the long term.   

Right from the day Streeting is in office, there will be a demand from most of the public not to privatise the NHS, while others will be urging him to embrace the private sector, and consider a combination of state funding and personal insurance.    

That “go more private” will not be as easy to brush aside as some think.  Consider this Q and A: the NHS in Scotland is a wholly owned public utility in which the private sector is not involved, or only marginally, Right?  Wrong. A number of hospitals are wholly owned, but a number under the Private Finance Initiative, like the Royal in Edinburgh, are owned by private interests. Primary care, the GPs, are private sector contractors. The prescriptions they give us are taken to private sector pharmacies.  The drugs they dispense are supplied private sector companies.  In short, while the NHS is not wholly owned, it is wholly funded by the taxpayer.

Given that considerable historical and existing private sector involvement in the NHS, the argument will run ”Why in principle should we not consider the insertion of another private sector component, insurance, which will have the benefit of a lower level of taxpayer funding?”  Well, there is this counter-argument: that it is one thing to pay for private sector buildings, and services, quite another to introduce a new fundamental principle of a private funder who will decide whether or not a person gets the medical treatment they need.

The ultimate logic of the private insurer deciding on treatment, as opposed to medical attention at the point of need, can be witnessed in that home of medical insurance as basic to  medical care – the United States.

Reported in the Wall Street Journal 10^th May this year, Heather Miconi has seven weeks to find $2,000, through appealing to a Go-FundMe campaign group, to pay for her daughter’s surgery to allow her to breathe more easily. Her insurance won’t cover the cost. She works three jobs and has no cash available. Ms Miconi is not a one-off.

United States data from 1,850 hospitals and other health care services revealed:

• 23%  of hospitals demand pre-payment for knee operations, CT scans, and births. 

• 43% of people postponed getting medical care because of no insurance cover.

• 64% people postponed medical care because they still had debt from previous medical bills.

• 39% didn’t take prescriptions to a pharmacist, or cut pills in half, or skipped doses of medicine.

• 33% did not get a medical test or treatment from a doctor because of no insurance cover.

But even in the USA, where their lobby has made anything different from insurance condemned as socialist, only 65% of the population is covered in that way, with 34.8% of the population relying on Medicare or Medicaid, the former Federal funded and the latter a Federal/State combination.  9.3% of children in poverty under the age of 19 have no cover at all.

The business of the known/unknown

Insurance companies need to make profit, to pay dividends to investors and improve their operations. Their business is in the known-unknown.  They know something will happen but not when, where, what it will be, and to whom. Therein lies an inherent risk, different from the risks by many other companies.  Insurance companies have developed methodologies to assess risk, but even so there is always the unknown that becomes known, with a price.

What they do in practice is spread the risks by offering the customer a range of products of different coverage and, of course, different prices.  The latest Direct Line car insurance advert is a good basic example, with its three different levels of cover, pitched at sections of the car owning community who have different disposable income levels.  

That same format applies to whatever system of private insurance is issued, including medical insurance. There is no way, by bringing private insurance into NHS as a funding mechanism, that the poorest in our society will get the same cover as the well off. 

I was born and experienced a life before the NHS was set up.  I know better than any succeeding generations just how liberating it was.  A great background fear and anxiety was abolished.  It was in comparison with today a basic rudimentary service. In today’s monetary value it was funded on around £11 bn in 1949, whereas today, a much-changed service by the advancement of medical science costs £181.7 bn.

How we can spend that gigantic sum and have an NHS with people unable to see a GP when needed, expanded waiting lists of people in pain, failure of diagnosis in many cases, is the reason why we need to look at what is wrong, and make the changes required. What those changes are, how they will be identified, will be the first big test of the incoming Labour Government.  I hope the Scottish Health Minister will be willing to join in.