Tag Archives: NHS

Britain, Economic, Government, Health, Politics

Politically the NHS is non-negotiable. That has to change.

NATIONAL HEALTH SERVICE

Intro: The philosophy and funding model for the NHS is not fit for the 21st century. To fix it, we first need to admit that the NHS is broken

THE centrepiece of the opening ceremony of the 2012 London Olympic Games was a celebration of the NHS. This was understandable: the host country was projecting a healthcare system that is uniquely British.  

In this case, however, a description of “unique” says something deeply worrying. For it is uniquely British only because no other country has ever sort to copy or replicate it. The world was watching that Olympic opening ceremony, but no other country looked at those medics dancing energetically around the beds of their smiling patients and concluded that this was an institution they wanted to introduce into their own countries.

It is surely reasonable to ask, why not? And what does that say about the NHS?

There is no doubt that much of the public adoration of the NHS is founded on fading folklore memory of pre-1948 Britain when millions of people suffered illness and premature death because they could not afford to pay for a doctor. That obscenity cast a long shadow, but it’s time to consign such memories to the archives of history.

Most other countries, after all, have very similar histories. Britain was not unique in its suffering from appalling health inequalities in the past, or in its strident attempts to seek a better, more equitable way of looking after the health needs of its post-war population. Other nations faced the same challenges, and they arrived at different solutions.

But in Britain there can be no solutions other than the one that Nye Bevan, the Welsh MP who served as health secretary in the post-war Labour government, came up with more than 75 years ago.

We may live in a world transformed, a globalised world of advanced technologies undreamed of in the past century, a world of instant communication, high-powered algorithms, and artificial intelligence, but when it comes to health policy, Nye’s unflinching word is the secular equivalent of holy writ set in tablet and stone.

And heretics who doubt his word by quickly casting to the wind any suggestion of fruitful reform are castigated as malign. But maybe, just maybe, not everything the NHS does, and the way certain things are done, are perfect. Perhaps there are alternative ways of funding it, and that there might be lessons to be learned from the way other modern democracies provide healthcare for their own citizens.

Such is the current state of debate – stifled at every opportunity – and, yet the NHS is arguably the most important institution in the country. Funding has never been unlimited; the system has been stretched to its limits in recent years, resources are inefficiently allocated, and the country is still expected to provide a healthcare system for everyone based on 1948 ideals.

The combined cost of health services in England and Scotland is nearly £200billion a year. Despite this, still one in seven Scots languish on waiting lists for treatment. Economists predict that the funding crisis is only going to get worse as our population ages.

Why shouldn’t we be addressing these issues in a full and frank public debate? It would, after all, be in the interests of hard-pressed taxpayers’ who fund in full NHS services and provision.  

But every time politicians even raise the possibility of doing things differently, they are shouted down, accused of wishing to “privatise” the NHS or – worse – introduce an American style service that only the wealthy can afford, leaving the vast majority of people in Britain at the mercy of exploitative private health insurance companies.

And so, the unsustainable status quo goes on, with our political parties too frightened to explain exactly how they will address the demographic time bomb that is looming.

There are only two politically acceptable “solutions” to what now seems like a permanent NHS crisis: more funding – and even more funding.

Our politicians need to be slightly braver by showing some courage, by being more imaginative, and less terrified of incurring a disapproving look from voters. They need to be honest about the challenge we all face.

They would concede that a funding and organisational model brought into being a matter of months after the defeat of the Nazis, might not necessarily be the right model for healthcare in the third decade of the 21st century.

Could it be that any constructive criticism of the NHS, or any new thinking about alternative ways of funding healthcare, are shouted down because the arguments for maintaining the status quo are too fragile to withstand robust scrutiny?

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WHY, then, faced with criticism of the NHS, do its defenders seek falsely to claim that the only choice is between what we already have and the admittedly dreadful service that American citizens must tolerate?

Why not admit that there are plenty of other health services in the world – systems that use a variety of funding mechanisms? And that many of them have better health outcomes than in the UK? Is it seriously being suggested that Britain has nothing to learn from those other countries?

The facts do not come any clearer. Britain comes nowhere near the top of league tables when international comparisons for cancer and cardiovascular survival rates are compiled. We even fall behind the United States on many metrics.

In a country whose society has been so fractured by our public debate about Brexit, it is extraordinary that even the most ardent Remainers, those who insist that the EU is better, more progressive, more caring, more tolerant than the insular, old fashioned, short-termist Britain, will draw the line at healthcare. We should all be more European in every aspects of our lives, they say, except when it comes to healthcare.

Germany, for example, has a healthcare system funded by a combination of public funds and private insurance. Its health outcomes, including life expectancy, puts Britain to shame.

The country has a public health system, but it’s financed in a radically different way from the NHS. Around 86 per cent of Germans are enrolled in schemes run by not-for-profit insurance organisations known as sickness funds. They choose which fund they sign up to.

These are paid for by deductions from wages with employee and employer contributions. Some small out-of-pocket payments are required for hospital visits and medicines.

The healthcare system in Germany is also better staffed than it is in the UK, relative to the population. Analysis by the Nuffield Trust in 2019 concluded that the UK had around nine nurses per 1,000 people, while in Germany there were about 14. The disparity in bed numbers was wider too, with Germany’s eight beds per 1,000 more than three times the UK figure.

In France, the healthcare system is funded by social security contributions, central government funding, and partly by patients themselves, who have to pay a percentage of costs for medical treatment or prescription drugs. Like the UK, France provides healthcare to every resident regardless of age, income, or status. But life expectancy for French women is the second highest in the world.

The healthcare system in Italy, also provided through a mixed public-private system, is considered one of the finest in the world.

Worryingly, a recent report by the King’s Fund concluded that Britain’s life expectancy rates are among the lowest in Europe.

As local health surgeries struggle to cope with the aftermath of the Covid pandemic, the dreaded 8am rush to get a GP appointment has become the bane of most people in this country. And every winter heralds a new crisis of hospital bed shortages.

And still the NHS is plagued by industrial action by nurses and junior doctors, who feel they are unrewarded, and have become cynical about their working practices and conditions of employment.

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ACCORDING to the Organisation for Economic Cooperation and Development (OECD), the UK spends more on healthcare than comparable countries (about 11.3 per cent of GDP in 2022), but has fewer hospital beds and diagnostic tools, and pays nurses less.

Across the countries studied by the OECD in 2021, there were on average 4.3 hospital beds for every 1,000 in the population. But in the UK the figure was only 2.4 beds for every 1,000. Only Mexico, Costs Rica, Columbia, Chile, and Sweden, reported lower ratios.

So, what, if anything, can be done to improve things?

The first course of action should be to decide not to rule anything out. And yet that’s exactly what our politicians have always done.

Even when solutions are staring them in the face, they will insist that if it’s never been part of the NHS before, then it shouldn’t be in the future either. Even when other countries have successfully tried and tested those exact solutions.

The UK needs to be wiser about how to spend scarce resources. Every so often, a brave politician will tentatively suggest that patients should pay a small sum towards their GP appointments, or even be fined for failing to keep an appointment. But they are soon shouted down and told to behave themselves on pain of deselection or electoral defeat. The NHS is a political bargaining chip that is so entrenched with the electorate that political parties cannot budge over. Any governing party holds it as sacrosanct.

In Scotland, the introduction of free prescriptions for all was a major boost to the incomes of those already wealthy enough to pay for medicines. But woe betide any political party that might seek to reverse this redistribution of wealth from the poor to the rich.

Switching to a European-style social health insurance system would be no panacea – what works in one country could not be expected to work precisely the same way elsewhere.

But what does it say about the state of public debate in Britain that such a reform is immediately dismissed as being beyond the pale?

Germany, France, and Italy are hardly basket cases, or third world countries. Until two years ago, they were among our most important EU trading partners.

The question for policymakers should not be how best to preserve the NHS as it is, but rather how patients’ interests be prioritised?

The NHS was created to serve the country, not the other way around. It is not there to provide employment for its million-plus workforce. It is not there to create jobs for an army of administrators and bean counters.

And it certainly doesn’t exist to provide well-paid work for diversity, equity and inclusion officers, whose numbers have exploded in recent years with no measurable improvement in the quality of care given to patients as a result.

It exists for us, the UK citizens who pay for it with our taxes. That is its primary, if not its sole, function. And as the funders of the NHS, we should be insisting that it is no longer run in the shadow of a past that is viewed through rose-tinted glasses.

We should demand that it becomes a modern, flexible, dynamic, and innovative service.

We could start by shattering a central shibboleth of faith in the NHS: that privatisation is somehow alien to it, with its only aim to make profits from vulnerable patients.

In fact, the private sector is an essential mechanism for providing essential health services. Opticians and dentists, for example, earn much of their income from privately paying patients.

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EVEN local GP practices, our primary interface with the health service, are essentially private companies contracted to provide services to the NHS. No one in this country gets through life without dealing, at one point or another, with a private provider of healthcare services.

Institutional and financial reforms are necessary and inevitable at some point. But we as ordinary citizens must shoulder some of the responsibility for helping improve the nation’s health.

Far too often we have allowed politicians to convince us that our poor health – whether from being overweight, drinking too much alcohol, not taking enough exercise, or smoking – is not our responsibility, but is the fault, somehow, of the Government, or the food industry, or advertisers.

We are told to believe that we are powerless, susceptible to the diktats of these external forces.

We eat too much because planning laws allow too many fast-food restaurants to be built. We eat fatty, processed foods because we were never taught to cook properly at school. Many people smoke because they’re influenced by Hollywood stars doing the same on screen.

It’s all a big, dangerous lie. We choose what to eat and what lifestyles to pursue. If we rely on the Government to tell us how to live and to intervene to force us to make better choices, we surrender all responsibility for our own lives and our own health.

The combination is lethal. We rely on the Government to govern how we live and what we eat, and then demand that the health service we pay for through our taxes delivers better results, even as we rule out any kind of radical reform that might improve that healthcare system.

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Britain, Government, Health, Medical, Society

One of Britain’s top medics says we need an NHS fit for the modern age

NATIONAL HEALTH SERVICE

PROFESSOR Stephen Smith, Dean of Medicine at Imperial College London, has been making his professional views known on the state of the NHS. The leading medic says that the service will never improve until the entire system has had radical surgery. In a brilliantly argued prognosis, Professor Smith has seen first-hand how the rest of the world almost always delivers better health care and says it is not about the money.

As a consultant gynaecologist and professor, he once advocated a change in the appointments system at one of the best hospitals in the country – the Rosie Hospital which is part of Addenbrooke’s in Cambridge.

The existing arrangements saw one batch of women called in at 9am, another at 11.30am. The medic became increasingly tired of seeing these patients sitting in the waiting area, often agitated and fed up.

He cites a woman who comes through the door having been made to wait for more than two hours and who is understandably angry, tired and resentful, especially as she’d been trying to entertain a screaming three-year-old. The clinician says you’re not going to get the best account of someone’s medical history in those circumstances.

He thought individual appointment times would be better: say, one every 15 minutes. Every doctor and patient he spoke to agreed.

You would think it easy to get things done for someone who is a professor in the NHS. Senior doctors are revered: their opinion and judgements count. But try to actually change anything and it’s a different story.

Naively, Professor Smith thought the switch to a 15-minute appointment system would be easy. Instead, he had to argue his case in front of at least six committees who each have a separate chairman and differing agendas.

That instance was just the first of many of his battles with the staggering bureaucracy within the NHS.

Next, his unit pioneered a scheme whereby pregnant women would carry their own medical records to appointments instead of looking up their records on the central database. The opposition to this was ferocious.

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PROFESSOR SMITH’S unit pointed out that 17 per cent of central records could not be found. And once women were trusted with their own notes, only 5 per cent turned up without them.

He also mentions another arduous battle in which post-appointment letters are sent to the patient, with a copy to their GP – instead of the other way round.

At the heart of this chaos, he says, is a system that doesn’t put the patient first. The hurdles placed in the way of reform are designed to shore up the NHS – and are not in the best interests of the people who need it.

After Cambridge, Professor Smith became Dean of Medicine at Imperial College London, then CEO of the Imperial College Healthcare NHS Trust. He has also worked in Singapore and Australia.

Having had a view of our healthcare system from many perspectives, today’s NHS, he says, is simply not fit for purpose.

The additional funds the Government is about to direct to the NHS – some £36 billion over three years thanks to a new “Health and Social Care Levy”, including £5.4 billion to help clear the backlog caused by Covid – is well intentioned. But throwing money at the current system won’t get us anywhere.

We have been furnished with yet more stark reminders of the eye-watering sums the NHS is capable of wasting. It reportedly paid around £400 million a month last summer to block-book private hospital care for non-Covid patients.

A good idea, many might think. But astonishingly two-thirds of that went unused, perhaps for ideological reasons. Many NHS staff have an aversion to private medicine.

Meanwhile, waiting lists have grown. About 5.6 million people are waiting for hospital treatment, and that number looks set to double in the coming years.

Some £9 million of the new money is already earmarked for salaries of up to £270,000 for executives who will be expected to “actively champion diversity, inclusion and equality of opportunity”.

The medic says he has no quarrel with high salaries if they help to attract highly competent people. These are, after all, important jobs. When Professor Smith was chief executive at Imperial College, he was responsible for a £1.2 billion-a-year budget and had people’s lives at stake.

His prognosis says it’s time we had a major review of the way we run our health service. The NHS was born from such a review: the famous 1942 Beveridge Report, which looked at health care, social care and education. It was marvellous and set up an NHS that was suited to life 80 years ago.

We need now to set up a new Beveridge review. A national debate should be had about how to best fund and run our health service for the 21st century.

The review could be a Royal Commission, it could be an inquiry led by a judge. But, he says, any inquiry should typically involve medical personnel, economists, social-care experts, politicians, and patients, while avoiding childish, political squabbles. And we need to ask: what do we want, and how do we pay for it?

Professor Smith’s analysis says there are other, far better ways in which we can pay for healthcare in this country. The best would be the social insurance schemes seen elsewhere in the developed world – which would offer a vastly superior service than the one we have now.

The biggest obstacle to bringing in social insurance is actually the English language. When you mention social insurance, people in Britain almost freeze. They think: “I can’t afford medical insurance!”

But it’s not at all like private medical insurance – that’s completely misleading.

Under a social insurance scheme, the Government “hypothecates” – that is, promises – the money to go on healthcare. The scheme is then run-on insurance principles, but it’s paid for by the state out of taxation. And the money cannot be used for anything else.

Be wary of the objections from the Department of Health and the Treasury that social insurance is complicated and difficult to manage. We know through international comparisons that it provides a high standard of care – often higher than the NHS.

Many will have been cheered to see that the levy the prime minister announced last week will be hypothecated for health and social care. That’s a small step towards a proper system of social insurance.

THREE

THIS has nothing to do with “privatising” the health service, nor is it a criticism of our health professionals who have shown – especially over the past two years – selfless dedication. It is about dramatically improving healthcare in this country.

The great myth about the NHS is the belief that, because it provides for everyone, it is exceptional. But do people here seriously think the citizens of Belgium, Holland, Germany, New Zealand, Australia, Canada, Sweden, Switzerland, Denmark, Norway, Spain and Italy all go around worrying about whether they will get treatment for any condition they may have? Of course not.

All these countries have slightly different systems, so our NHS review could look at the right mix of options, taking ideas from several countries, perhaps, to get the best for the UK. 

Professor Smith highlights the Dutch system, which has a small number of sickness funds which patients can switch between without penalty.

As a nation, the medic says, we’ve set the bar far too low: grateful to see a GP after several weeks’ wait, grateful to have surgery, if only after the millions ahead of us on the waiting list have had theirs.

The truth is, he insists, is that we can do better.

Explaining that when he was a young doctor, the clinician was filled with fervour for the NHS. He had the fiercest arguments, insisting our system was the best in the world. Then he began travelling to other countries as part of his academic research into menstrual dysfunction.

Much of his early research was done in Sweden. That was his first eye-opener: the Swedish system was outstanding.

One of the first things that impressed him was that consultants went outside their hospitals and held clinics in GP surgeries.

That was enlightening and certainly new to him. In Sweden, the consultant was expected to go to the patient, not the other way round. That is still a feature of Swedish medicine and we should look at it closely.

Right now, too much in healthcare isn’t right for the patient but persists because “we’ve always done it this way”.

And as for privatisation? When people talk of “mixing public with private”, there’s a widespread suspicion that evil American corporations will descend and make huge profits from “our” precious NHS.

But – and here’s the key point – large parts of the NHS are already private.

In the many years of working in hospitals, Professor Smith has never understood why so many people haven’t realised that GPs don’t actually work for the health service. They are small businesses. So are dentists, including those offering NHS care.

The first criticism from the Left is always, “Look at the American system!”

Professor Smith acknowledges that the American system is atrocious – not to mention terrible value for money. Many people live in fear of not being able to pay their medical bills and care costs twice as much as anywhere else in the world. Nobody wants that. What would improve Britain’s healthcare is a system like those of many of our European neighbours.

The biggest challenge for the UK health service now is how to integrate primary care (GPs, dentists and opticians) with secondary care (including hospitals). This comes naturally in a less “top-down” social-insurance system.

FOUR

SOCIAL CARE has long been neglected, but it is key to making the whole system work. It’s about getting older and vulnerable people home from hospital, rather than leaving them stuck there when they no longer need to be.

If Mrs Jones, 95, is ready to be discharged but social care can’t ensure she will be looked after at home, she must stay in hospital. Then the bed she would have vacated is not available for the next person needing an operation, and so on…

Lack of integration in the NHS is systemic: most patients are astonished, the professor says, at the difficulty of sharing records between a hospital and general practice.

The clinician says that if you are assessing someone’s health needs, you should be able, with their consent, to access their primary care records, operation notes and anything else that is relevant. But this is very difficult – although technology is slowly improving matters.

Professor Smith poses a final question. Should we now change the role of GPs to focus more on long-term care?

The medic says that if you are a woman with problem periods, say, why shouldn’t you access an app, put in your medical history and refer yourself to a consultant whose team will be able to look at the problem and decide if you need to come and see them? Why should your GP be the only port of call?

This final point brings Professor Smith back to his key point. The NHS as we have it was designed for life 80 years ago, when your GP was the person – invariably a man, in those days – who acted as a gatekeeper.

That was then, he says. What we need now is an NHS for the current and modern era.

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Britain, Government, Society, Technology

Artificial Intelligence (AI) is the future of the NHS?

HEALTHCARE

TIME is money, and for the NHS crucial in how it operates. A government which cannot get waiting lists down, for example, risks public ire. Gaping chasms in service provision would mean shelling out on locum doctors and private procedures.

Commonly, the government bows to popular pressure and loosens the purse strings, which might involve unpopular tax rises.

Yet, there is another way – one that would put an end to long waits, understaffing and bed-blocking. Artificial Intelligence (AI) could transform the NHS into a lean, hyper-efficient, cost-effective modern medical system. It may sound far-fetched and even sinister, but the age of automated medicine is already upon us. The question is, will we benefit from it or retreat through lack of will or vision?

Some 40,000 patients in London have signed up for this brave new world. They are registered on GP at Hand – a chatbot, or online conversation simulator, capable of screening symptoms and referring patients either to a GP for diagnosis or another service.

Babylon Health, developer of the technology, announced earlier this year that the latest version of its app could diagnose ailments with at least as much accuracy as a GP, in some cases more.

The chatbot was tested against 100 patient scenarios and assigned questions from the Royal College of General Practitioners (RCGP) membership exam, the assessment all GP trainees must pass to be fully accredited. On its first attempt, the chatbot achieved a pass rate of 81 per cent, which Babylon has been keen to contrast with the average score of human GPs – 72 per cent.

 

THE next generation of GPs could look more like an animated robot that pops up on your smartphone or other electronic device. GP at Hand cannot prescribe medicine, for now, but the scope is there to develop products such as this into an autonomous all-round primary care service. In the GP surgery of tomorrow, the app will see you now.

Dr Ali Parsa is founder and chief executive of Babylon. He says his company’s product makes primary care more affordable and accessible but not everyone is convinced of the case for robot-GPs.

The RCGP is by no means Luddite but it makes sceptical noises when asked about AI annexing large parts of the primary health terrain. Every day the NHS delivers care to more than a million people across the UK, taking into account the physical, psychological and social factors that impact on a patient’s health. When formulating treatment plans, medical practitioners consider the different health conditions a patient is living with and the medications they might be taking. Some may say that no app or algorithm will be able to do what a GP does.

Much of what GPs do is based on a trusting relationship between a patient and a doctor. Research has shown that when GPs have a gut feeling something is wrong with a patient they are frequently right, even where there is a lack of obvious clues to a diagnosis.

Despite such misgivings, momentum is with the tech pioneers. A world of choices is opening up. Apps and chatbots are putting control in the palm of our hand and, once patients get a taste of choice, they will not give it up easily. In fact, they will only want more.

The hospital operating theatre is also at the vanguard of the medical tech revolution.

The da Vinci robot, in use in parts of Scotland, replaces the surgeon’s scalpel with a computer console. The surgeon guides robotic arms, which perform all the necessary moves. This allows operations to be carried out more quickly, less invasively, and patients can be discharged in days.

In the future, surgical robots could be controlled so remotely that the finest surgeons in the United States perform the most arduous operations on patients thousands of miles away in some of the world’s poorest countries. Eventually, surgeons could be removed from the equation – or see their role changed to one of programming and overseeing fully autonomous surgical bots.

Technology is also our best defence against some of the biggest killers out there. Consider, for instance, the work of Memorial Sloan Kettering, the leading US cancer clinic, who have combined with computer giant IBM. Together they have developed Watson Oncology, which runs a patient’s symptoms through a database and arrives at the optimal treatment plan.

At the high-end of oncology, this may reduce the time spent selecting the right treatment from months to minutes. In a field where time is a matter of life and death, programmes such as Watson allow doctors to share information, begin therapies sooner and, it is hoped, improve survival rates.

Imagine what such a system could do for priority waiting times and survival rates in the NHS. The effect would be transformative. It would be a game-changer and life-saver.

In Scotland, meanwhile, the mental health crisis has finally been acknowledged and even assigned a dedicated minister, but progress can only be described as achingly slow.

Support for those who suffer from depression, anxiety and other related conditions still takes too long to access and too many frontline staff know too little about the subject.

Cognitive Behavioural Therapy (CBT) is scientifically proven to treat severe anxiety, but for many health boards across Scotland this form of promising treatment simply isn’t an option, or if it is waiting times can be as lengthy as 18 months.

Of course, for every troubling experience with the NHS, others will have nothing but praise for the care received. But when it comes to mental health services, the NHS still has a lot of work to do.

Once again, AI provides part of the answer, this time in the form of Tess – a mental health chatbot designed by San Francisco start-up X2AI.

 

ITS founder Michiel Rauws drew upon his own struggle with depression to devise a bot that talks, listens and processes information like a therapist. Already being trialled in Canada, Tess is more than a Q&A programme: she records patients’ symptoms, emotions and experiences and stores them for future mental health episodes.

Tess remembers which stressors are likely to bring on a panic attack in a given patient and recalls what helped to lift another patient’s mood during their last depressive incident. Patients who lack the time, finances or confidence to see a regular (human) therapist can pull out their phone and be supported instead by Tess.

Such apps could give the healthcare industry the upper hand in the treatment of mental ill-health. For the NHS, it could dramatically cut waiting lists and buy the health service time to retrain medics to deal with mental health patients.

The tide of progress is rapid but turbulent, too. You need not be a clinical expert to recognise the dangers inherent in a dreamy techno-utopia of automated medicine.

Would software have built-in assumptions in favour of retaining a patient and therefore not making necessary referrals? How does AI replicate a doctor’s ability to spot warning signs of which a patient is unaware? Could an app, with enough autonomy and data, begin to play God and ration care according to a patient’s financial burden on the system or estimated longevity?

That’s not to mention the inevitable teething problems when any major tech programme is rolled out – except, with people’s lives on the line, mistakes cannot be undone with the click of a button. Then there are concerns over data security and patient privacy. Theoretically, patients could game the algorithm to jump the queue for a hospital referral or to access unnecessary prescription drugs.

These are among the primary hurdles which AI advocates must overcome, but most have a technological solution and can be tweaked out of the system as they arise.

More difficult is convincing those wary of the technology. Yes, AI could be the saving of the NHS – but for patients not au fait with apps and data and bespoke digitisation, all this talk of robotic surgery and GP chatbots may be confusing and unsettling.

Some are quite content to pop along to visit the GP they have been seeing for 40 years and do not relish the brave new world of Dr Finlay’s Chatbot.

AI has the potential to transform the NHS, but it must be implemented in an equitable way that enhances traditional GP services and doesn’t benefit some patients at the expense of others. Some patients love technology, whilst many others don’t. The health service must ensure that its use does not inadvertently widen healthcare inequalities.

Undoubtedly, this is going to take gradual reform, patience, and lots of public information programmes. The human dimension – of patient and doctor – must remain at the heart of the NHS ethos.

Ultimately, however, change is inevitable and technological innovation is arguably the NHS’s best chance of avoiding managed decline. Not only can it slash waiting times, reduce bed-blocking and improve patient care, technology is an answer to an increasingly unsustainable funding model.

Using AI to bring patients fast, cutting-edge treatment finally opens up an honest debate about cost. The private version of the Babylon app offers a free symptom checker but charges £4.99 monthly for unlimited access to a real GP. Included in the price are consultations via text message or video chat software FaceTime, 12 hours a day, seven days a week. One-off check-ups cost £25.

If the NHS can commission apps that meet all the basic requirements for primary healthcare consultations or outpatient services – reducing waiting times and freeing up staff in the process – there is a powerful case for offering patients the choice of faster care subject to a modest monthly fee. The principle of “free at the point of use” would continue, while such a scheme of rolling payments would not be very different from National Insurance, only voluntary.

Here is why the inherent conservatism of the public sector, quietly grinding its teeth up until now, would burst forth in full, Nye Bevan-quoting indignation. Such charges would be “a betrayal of the NHS”, “back door privatisation”, and all the other maledictions cast in the direction of even modest reform. There would be marches against a “two-tier NHS” and petitions for every smartphone in the land to be smashed to pieces.

It will take a great deal of political will to overcome vested interests and guide new ideas through the swamp of dirigiste group-think that passes for health policy in the UK. Any attempt to secure the long-term future of the NHS through reform, innovation and efficiency is met with wails of odium. Far from saving the health service from the evils of the profit motive, the reactionaries make it more likely the service will eventually collapse.

The Healthcare Quality and Access Index, the annual measure of the world’s best medical systems, places the UK 23rd.

This puts us behind Slovenia, with its mandatory and voluntary insurance tracks, and Sweden where patients must stump up co-payments to see a GP, visit hospital or even use an ambulance.

The NHS, while a proud national achievement, is nonetheless not the best healthcare system in the world – not even close.

 

CONFRONTING the reality – and setting aside sentiment and hysteria to accept that, across Europe, universal insurance-based models provide superior quality of care – allows us to ask some taboo questions. Could the NHS be made more cost-efficient, clinically effective and patient-friendly by introducing (modest) co-payments and fees for certain services?

Does AI hand us a laboratory to test patients’ receptiveness to charges? Will digital innovation steamroll over barriers to increased private sector involvement in health provision?

This is the real technological revolution in healthcare. An outdated model of funding and provision may not be able to withstand the momentum of rapid change, rising patient demand, and even buy-in by clinicians. If the NHS accepts the need for change, it can reform of its own accord and harness technology to safeguard Britain’s universal healthcare system for generations to come.

If it digs in its heels and puts roadblocks in the way of progress, it makes it all the more likely that the health service will have to undergo radical, painful surgery down the line. Allow the NHS to drift down that path and it will have a great deal less influence over where it ends up.

An NHS powered by AI could compete with some of the finest healthcare systems in the world. It would be speedy, nimble and sustainable.

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