Saturday, 22 January 2011

NHS Reform

This is a difficult one. There are many different forms of the NHS around the world. Some work well, some don't. Some cost more, some don't.  There is no such thing as a perfect health service, if you want a better service you have to pay for it.
The USA spends twice the amount per head that we do in private insurance and has worse death rates in nearly every area (but they do have nicer teeth) while some of the Nordic countries spend twice the amount we do on their health services through direct payments and have some better and some worse results than we do.
My belief is simple. Our service tries to do too much and spreads itself too thinly. I believe that the NHS should concentrate on the core values and ensure they are delivered swiftly, professionally and free to all. However, in order to achieve this I believe that the private health care sector needs to expand to a stage where it can relieve the pressure from the NHS without substantially affecting its delivery of service.
The problem is 'What are the core values of the NHS?' Which areas are important to everyone and why?  I don't have the answer to this, I only have what is important to me, but if I knew exactly what was and was not provided by the NHS, I could make provision for the areas I needed through insurance or something similar.
How do we decide on the core values? 
Here is a novel idea - ask people. The current reforms aim to remove the 'top down' approach and give control to a group of people who have no experience of managing budgets or planning budgets at all. Doctors are great at making people better, politicians are great at lying but neither are very good at financial budgeting over a three year fiscal cycle. If anything giving control to GP's would open the system to corruption in an American style revolution - it would not create a British solution.
So why not ask the GP's, Doctors, Nurses and general public about their priorities. Lets find out exactly what we want and why we want it - lets ask the professionals (and I mean all of them - not just the ones that agree with politicians) for the best way to run the service and lets ask people with ideas for new solutions to old problems.
Then, when we have got an agreement on what we should aim for and how it should be run - this is the bit that will frighten politicians - take control of the NHS out of the hands of government and politicians. Get all main parties to sign up to a twenty year plan with a review of specific targets every five years (at least two years after an election) so that there is a consistent and supported plan with no danger of it being de-railed by political whim.
One final point, the inevitable expansion of the private sector needs to be more managed in line with the needs of the country than it is currently. Again the over centralisation of services only serves the needs of certain parts of the country and creates resentment and non cooperation from those parts not served. I would suggest that if a private hospital wants to be built in a very profitable area e.g. London - then a hospital of the same size and service level should be built in a more deprived area to compensate e.g. The Welsh Valleys. If the company wishes to make any changes to one they must change both and both must be open to a certain level of NHS services as well.

I hope I have generated a few points to ponder here - I genuinely don't believe that anyone group has the answer to the NHS - but I do believe that if everyone works together a much better solution can be found.
Your comments are always welcome.

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