what to expect from Cameron and Clegg’s NHS

What you expect from the NHS

It may seem a statement of the obvious, but you expect the National Health Service (your GP, your hospital, your community health services) to provide healthcare services.

When you or  a loved one is unwell,  you want medical professionals to offer the best expertise,  judgment, and treatment. You do not want to have to work out for yourself the best treatment and the best way to access it: offering you “individual choice” is unhelpful and meaningless.

You do not expect competition between the different parts of the healthcare system and particularly between the medical professionals, but collaboration and co-operation: you would think it absurd or obscene for such co-operation to be punishable by law.

You expect treatment for chronic or complex conditions to be co-ordinated.

You expect services – even those judged to be of lower clinical priority – to be provided free of charge.  After all, you have been (and will continue) contributing to the NHS through taxation and National Insurance, and expecting the Government to fund and manage the NHS responsibly.

You do not expect to be forced to take out health insurance to get treatment; and you feel secure in the knowledge that the cost of treatment (or health insurance) will not drive you or your business to bankruptcy.

You expect a member of the current government to be responsible and ultimately accountable for the NHS, and for the service to provide the best value for money. You expect that you can use the democratic process, including elections, to influence the priority given to the NHS for government spending.

You do not expect funding for the NHS to be diverted into profits for private healthcare companies, perhaps especially foreign-owned corporations.

You expect to be treated on the basis of clinical need and priority. You do not expect to be queued behind people who can afford to pay for treatment or better health insurance.

You have these expectations because the National Health Service, established after World War II, was based on principles which produce this service.

Ian Greener, a Professor of Social Policy, has set out his personal understanding of these principles in a recent blog.

  1. Access to healthcare should be based on need. To deny treatment because someone cannot afford it is inhumane.
  2. To guarantee such universal access, public provision is necessary.  To think this can be replaced with private provision is foolish.
  3. Public funding of healthcare is efficient and redistributive
  4. Healthcare is complex, and it is difficult for patients to make judgments on accessing the best treatment
  5. There are no simple organisational fixes to providing healthcare. Anyone who suggests otherwise is an ideologue.
  6. Competition between healthcare providers will not work.

The Coalition Government’s vison for the National Health Service, and the changes it proposes in the Health and Social Care Bill currently before Parliament and which the Coalition intends to be signed into law by March 2012 can be summarised as follows:

  • Every expectation you currently have of the NHS as a healthcare service will be undermined or simply turned on its head.
  • Of the six principles proposed by Professor Greener:
    • Access to healthcare will be based on the ability to pay
    • Private provision will replace public provision
    • You will pay for health insurance on top of taxation
    • Patients will be offered (forced to make) choice. Getting treatment will be equated to buying bananas.
    • This reorganisation is the solution to all healthcare problems
    • Competition between healthcare providers will be the way the NHS will be made to deliver healthcare.

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