ja_mageia

Finally... some sense on the NHS.

The recent furore over the funding and reform of social care for the elderly seems to have abated for now, but the problems persist. Currently, the government only provides free care for those with assets under £23,000, who are also judged to be worthy of care by their local authority. This is grossly unfair - not only does the access to state-funded care vary significantly by area as local authorities will fund anything from those with moderate to critical needs, but those just above the threshold are forced to fund their care entirely, often necessitating the sale of their home, and penalising those who saved for old age.

With such perverse incentives, the already burdensome demand for state-funded social care can only grow as more people opt to spend their wealth and qualify for free care. Replacing an all-or-nothing threshold with a more tapered form of funding may go some way to help.

However, many still believe that social care services would be free based on need alone rather than wealth. Those ignorant of the system may underestimate the extent to which they must save up for old age (or in the case of the perverse incentive, spend for old age!) and consequently suffer. Public information may be justified in this case by making it clear that saving up for private forms of insurance may be necessary. This could further reduce the cost of state-funded care.

Another grave problem is with the quality of care. It varies widely by council, and choice is minimal. Personal budgets, allowing users of state-funded care to choose their providers have been trialled in some areas, but not extended. This is a shame, as they also counter a further problem with the current system: the ambiguity of funding streams.

Local authorities could also counter problems with quality by breaking open the monopoly on state-funded care homes or services. The contracts issued allow providers to exercise a monopoly on state-funded care for the duration of that contract. There could be perpetual competition between social care providers if they were instead paid per person eligible for free social care.

Harriet Sergeant's article in Saturday's Daily Mail said almost everything that needs to be said about the current state of Britain's National Health Service. I heartily recommend reading the whole thing. In the meantime, here are a few edited highlights...

On public sector inefficiency:

But how on earth will it cope with the exploding number of elderly patients and the costly new procedures and treatments coming on to the market? The answer, says the health think tank the King's Fund, is to increase productivity in the NHS. But over the past decade, it fell by almost 4 per cent. (Over the same time, it rose by almost 23 per cent in the private sector).

How could this be?

I had not realised how costly the actual structure of the NHS is until I sat in on a hospital board meeting. Making sure the hospital complied with the latest government initiatives dominated the agenda. We didn't discuss patients, improving care, saving money or any issue relating to the hospital. The focus was on the bureaucratic process. The initiatives did not come cheap. The board has to prove to the DoH it is complying. So, for nearly every new initiative, the hospital appoints a manager, often on £50,000 to £80,000 a year - not to mention a secretary - to collect the all-important data that must then be submitted to the Department of Health.

The result?

The effect of this is clear. One consultant calculated the proportion of managers, administrators and support staff to nurses in the NHS is 41/2 times greater than in private hospitals, which are not subject to the government initiatives.

Why doesn't someone do something about it?

I spoke to one non-executive director who has a career in trouble-shooting ailing companies and who was astounded by the attitude of his local hospital. With only a cursory look at the books, he announced he could save £200,000 just by good accounting. The response he got? 'It was as if I was speaking Ancient Greek.' His ideas were dismissed as not applicable in a service funded by the Government. Worse, the hospital's chief executive feared that an investigation might expose failings and leave him vulnerable to political interference.

The real problem:

The problems with NHS finances are bound up with the problems of the institution itself. It was designed to be state- owned, centrally planned, financed and run. Until we engage with that basic premise, the NHS will continue to be inefficient and expensive. And we'll see more hospitals closed and front-line staff cut. It is clear to me that we can no longer afford this top-down approach. But where do we go from here?

The solution:

I believe that instead of devising its own solutions to problems, the Government should cease to micro-manage our healthcare. Instead, it should be creating the opportunities for individuals and companies, inside and outside the NHS, to come up with the most efficient and cost-effective solutions, with the Government's role as strictly regulatory.

I really couldn't agree more...