Friday, 25 August 2017

The National Health Service

Recently I posted a blog entitled 'A Personal Vision for Britain" ( in which I wrote the following:
It seems to me that the National Health Service is unaffordable in its present form.  What is needed are ideas on total reform of the NHS (a blank sheet of paper, start again) nothing should be off the agenda. Form a group of Conservative minded people, but it must not be party political, to look at, discuss and brainstorm all suggestions. With an ageing population and the probability of rocketing geriatric medicine costs everything must be on the table. This includes Mental Health, Care in the Community and Old Persons Care Home costs.     
I then promoted the blog via Twitter and a person with the 'handle' of 'The Bald Colder' has been communicating with me on this subject. To be fair, 'Bald Colder' can only tweet in batches of 140 characters and we have had a healthy debate.  Here is a flavour of the 'Bald Colder' tweets as if I included them all it would take too much space. I am going to send a copy of this blog to 'Bald Colder' and give this person the chance to response. Their response will be published here if it is forthcoming:
Actually for the amount of money we put into the NHS, our patient outcomes trounce the American system.
The American system is horrifically inefficient because doctors over-prescribe because they are effectively on commission
Wow a Brexiteer where the penny has dropped we're in a giant ponzi scheme. With birth rate 1.9 we have to rely on immigrants
I'm more than happy to talk about healthcare in other countries but our problem is pure and simple: we don't put enough in.
What I would like to see is a tax that is specifically for the NHS and the gov't to compare results on a GDP per capita basis to our peers.
It was a quite a vibrant debate. I would like to see a national debate about what the NHS should look like now. I do not doubt its design was good for the 1940's but I am not convinced it is suitable for 2017.

I would like to see a committee set up to look at what the NHS should look like in the modern world. That committee should not include any elected politician (local or national) and be given a remit of 'here is a blank sheet of paper, what should the NHS look like?'

The chairman of that committee could be elected by a telephone poll. If you can vote for your favourite celebrity on 'Strictly Come Dancing' why not vote for your favourite candidate from a list to chair the 'NHS committee'? It would probably have to be confined to 11 members so it was not unwieldly. The person chosen to chair it, representatives of the Royal Colleges and of Patients would be nominated to sit on it.

On my blank sheet of paper:

  • Take a deposit to book a doctors or outpatients appointment - a credit or debit card payment (just like a 'contactless payment'). It would be, say £5. If the person turns up to the appointment, the money would be refunded; if not the hospital or practice would keep the deposit. (This would in all likelihood reduce missed appointments)
  • Make patients buy their own walking sticks, crutches or wheelchairs. A wheelchair on Amazon is £119.99. Patients would be free to donate them to the NHS after they had finished with them if they wanted to.
  • Do not fund any cosmetic surgical procedures (except for body reconstruction following cancer treatments such as Mastectomy).
  • Allow Local Authorities to buy groups of houses or build groups of houses in little 'villages' for respite patients, care in the community patients and to relieve bed blocking.
  • Consider whether local or cottage hospitals are a possibility for simple procedures
  • Is the current staffing structure fit for purpose?
  • Look at the salaries being paid to senior managers
It is already the case that those over 60 disproportionately take resources from the Health Service. It seems very likely that this cost will increase radically in the next 10 years or so - we have an ageing population.

I do not know if any of the above ideas are good ones or even feasible. 

What I am advocating is a fresh look 70 years after the template was first designed to see if it should have the same look. If it needs to be reformed or re-engineered, let the "NHS Committee" report that back. Equally, if the "NHS Committee" thinks the current model is the right way for the 21st century I would accept that.

Once the "NHS Committee" reports back and I envisage them having 2 years to compile their report, it would be published and a proper public debate of at least another year would follow.  

These are just my personal thoughts. If you are going to comment please keep the comments polite. I have no power just a desire to discuss the NHS in order to change it if necessary to make it the best it can be.

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