75 Years of the NHS – Time for Reform?
Sarah Gould examines the current state of the NHS on its 75th anniversary, and considers avenues for reform.
The National Health Service is one of the UK’s most prized establishments. For many, it brings a certain comfort to know that the NHS will be there in troubling times, whether it be for a broken bone or the treatment of a serious illness. But it is clear that the system is failing.
Waiting lists are at record highs of over 7 million. Some patients are forced to wait hours for a bed, due to the country’s critical care bed shortage. On top of this, thousands of NHS staff have been striking, and can we really blame them?
The average hourly wage for Band 1 NHS staff in 2022 was £10.37, a fraction over the National Living Wage. Even for the higher-paid workers, NHS salaries do not adequately reflect the long hours and stressful nature of the work. Despite these strikes being necessary for many NHS staff, they are having a huge impact on a healthcare system that is already at an all-time low.
However, the strikes are not the only prominent factor hurting the establishment. In the UK, there is a huge dependency culture on the NHS. Because people know they have access to free, available treatment when they need it, there is less of an incentive to stay healthy. For example, 6.6 million people in the UK smoke, and treatment of related health problems cost the NHS £2.6 billion a year. This money could be used elsewhere in the NHS, but as people have the free healthcare safety net, there is less of an incentive to quit. If the public had to pay for healthcare, they would be more inclined to take their health seriously.
If the public had to pay for healthcare, they would be more inclined to take their health seriously.
As well as unhealthy habits, unnecessary or easily avoidable hospital trips are a major contributor to high waiting lists and NHS costs. Accident and Emergency departments are overflowing and if you have ever seen the show ‘24 Hours in A&E’, you’ll know that a number of hospital trips are unnecessary. One episode had viewers slamming a man who went to hospital for a ‘stiff neck’. He was called out for wasting NHS time ‘just to get on TV’.
Furthermore, it is an all too common occurrence for people to end up in hospital after silly accidents, often when drunk. Again, as people know free treatment is available, they are less likely to take caution, and more likely to make unneeded hospital trips, meaning valuable NHS funds are being taken away from people suffering from serious conditions. Therefore, perhaps we should consider a system where taxpayers do not have to pay for other people’s mistakes.
So, how could we improve healthcare in the UK? Well, the NHS follows the Beveridge model for healthcare which sees the government funding healthcare for its citizens through income tax revenue. But there are other models to consider. For example, the Bismarck model of healthcare, otherwise known as the Social Health Insurance Model, which is used in countries such as France, Belgium and Germany. This system works by employees putting a proportion of their salary into a ‘social health sickness’ insurance fund, and their contribution is matched by their employer. Everyone is required to contribute a set minimum, but if they are unable to due to an especially low salary, unemployment, or even homelessness, they are covered by the government.
The fund covers most treatments, but there are exceptions. For example, there are extra costs for appointments that aren’t necessarily accidents or in which you are the reason for your poor health (e.g. smoking). But even in these cases, the government can ensure these costs are dependent on people’s economic standing by giving discounts to people from lower incomes.
Another benefit of the model is that wealthy people can opt for their own private healthcare, which makes social healthcare insurance more competitive, resulting in lower prices for everyone. Lower costs and more competition allow people to have more choice in their GP surgery, whereas currently in the UK, most go to the surgery to which they are assigned or which they are closest to.
Other possible healthcare models include the National Health Insurance model used in Canada. But considering Belgium is ranked world number 1 for healthcare (according to the Legatum Institute healthcare index), and it uses the Bismarck model of compulsory national health insurance, this may be a viable option for the UK to follow.
However, change is unlikely to happen anytime soon. After all, people tend to panic at the mention of reforming the NHS, and politicians are too scared to touch the sacred institution.