With NHS strikes having been in the news recently, I think it’s good for us to keep stretching our thinking about the issues involved. I’m going to do this over a few articles. My reason for doing so, is that I think Christians should be concerned about what happens in terms of society around us. Our aim of course should be to think Biblically or Christianly about these things. Of course there are no proof texts telling us how we should organise health care. However, I do believe that there are ways in which we can approach these questions from a Biblical worldview. First of all, however I wanted to pick up on some specific hot topics and try to tease out a little bit more background to get us thinking in two articles.
- Questions about NHS funding and management
- Questions relating to the recent strikes, especially Junior Doctors pay.
We’ll talk a little bit more about doctors pay in the next article. First, whilst the primary, presenting reason for NHS Strikes, not just with doctors but with nurses and others involved in the Health Service has been about pay and conditions, a major part of the narrative has been concern about the general state of the Health Service. We have just been through one of the toughest winters yet in terms of season pressure, especially on A&E services.
Three main charges have been made
- That the NHS is underfunded
- That the NHS is badly managed
- That the NHS is gradually being privatised.
Regarding funding, the UK spends about 11.9% of GDP on healthcare. This compares with 18.3% of GDP in the US. This may be surprising given the level of bad press that the US has and perhaps suggests that whilst a lot of money is spent via private health schemes that their system is not the most efficient. Meanwhile, France and Germany’s funding looks roughly comparable to the UK’s with 12.8% and 12.2% spent respectively. Australia spends less as a percentage of GDP on healthcare than the UK, France and Germany at about 10%. One question then is whether the issue is primarily funding or it is to do with how the Health Service is managed.
I also wanted to make some observations here about privatisation. It is a frequent accusation that certain political parties are out to privatise the NHS. However, that presumes that the Health Service is, or at least was not a private venture in any shape or form.
However, it has always been the case that Health Care has been at least in part a private venture. GP practices were from the beginning private, independent ventures, in effect contracted in to prove a service to the NHS. Meanwhile, alongside the direct, frontline provision of diagnosis and treatment, there are other elements that are crucial to healthcare including the supply of medication and equipment. These have consistently come from the private sector.
Meanwhile, it might also be argued that the introduction of the internal market when Kenneth Clarke was Health Secretary and its development into NHS Trusts, entrenched under New Labour, along with Public/Private Investment arrangements in effect amounted to a form of privatisation.
One argument is that the most important issue is not so much whether or not the Health Service is publicly owned as to whether it provides a genuinely public service, accessible to all and especially with healthcare free at the point of service. On those points, we might observe that:
- It has long been the case that healthcare has not been universally free at the point of service due to prescription charges, dental fees and charges for eyesight tests and glasses.
- That this has been getting worse, especially with regards to Dental Care as many practices are only offering private care options now and with long waiting times to join an NHS list. This means that at least with regards to dental care we cannot claim that it is either free at point of service or accessible to all.
Accessing those primary care services including seeing a doctor, dentist or nurse and getting prescriptions matter because failure to assess and treat at the early stages may well lead to more serious concerns later down the line.
So, in terms of UK healthcare, it has long been the case that the system is not so much a public one or a private one but a mixed economy. Perhaps that’s a substantial part of the problem. Consider for example the argument that people who pay to go private are actually helping the NHS because they are reducing pressure on waiting lists.
Now, I would not decry someone for choosing to use private health-care insurance in order to be seen sooner. I know of cases where being able to be seen sooner has been potentially significant in terms of life and death. However, although they may be seen quicker themselves, this doesn’t reduce the NHS queue. Why? Well because it is highly likely that the consultant and/or surgeon they see is working both in the NHS and the Private Sector. So, we are dealing with finite resources.
What private health care might be argued to do is to provide another revenue stream into health care. If one of the major resources within the system is the skilled labour employed and if doctors believe that their NHS income needs to be supplemented, then private healthcare in effect subsidises the cost of what those supplying the service are demanding.
However, I’m not convinced that this is a good way of going about things and this fits with the hypothesis that Health Care is not efficiently and effectively managed. This is however, just one part of the picture and in future articles we will consider some other aspects of it.