THE NATIONAL HEALTH SERVICE A SUITABLE CASE FOR PRIVATE TREATMENT
Just think of the world if in the 1940s the Labour government had set up a National Holiday Service in the UK. You can imagine their powerful case. All too many people in the 1930s could not afford a holiday away from home. The privileged few flew away to islands in the sun or took the steamship to New York, whilst the many stayed at home counting the shillings for the gas fire. It was not fair.
Many might have welcomed a free week's holiday by the English seaside. The government would have nationalised the hotels and taken over the buses and trains needed to get people to their welcome break. A fortune would be spent on equipping the travel and hospitality trades for the influx of 50 million tourists all patiently queuing for their week of free relaxation. Conversion of the big seaside hotels would provide new dormitories to accommodate so many people all at once, simple table d'hote meals to standardise the food buying, and mass transit from the big towns and cities. People would stand in orderly line for the bus, then for the train, and then at the check in at the Bella Vista.
By today it would all be looking rather dated and creaking at the seams. People want more than one week by the English sea, and do not want to queue. Maybe I would be asked to wait two years before I could have a week at my preferred resort, Bournemouth, and then it might not be August. Alternatively I might be offered a week in Scarborough in April if I wanted to go next year. There might be problems getting a reservation on the co-ordinating bus service at the same time as the bed in the hotel. For over the years, despite ballooning the amount of money spent on the National Holiday Service, the number of hotel beds in places like Bournemouth was cut back owing to staffing problems. Administrative costs climbed relentlessly. It costs a lot to disappoint so many people, answering all those letters and phone calls as people desperately try to book their fourth or fifth choice of holiday.
Radicals like me would now be saying we need to de-regulate, allow private competition, allow the private sector to build new hotels and allow me to go by car with all my luggage. Who knows, if we could harness the private sector we might then get individual rooms, a la carte menus, and a choice of places to go? Maybe we should pay less tax and buy our own holidays. I would be condemned. How dare he think that profit making businesses could safely look after people when they are vulnerable, trying to relax on holiday? How could he possibly allow people to make a profit out of leisure? Would the food be safely prepared if hotels were making a profit? Wouldn't some people be able to buy better holidays than others? Surely they would be queue jumping?
You might smile, or think this all far fetched. Yet that is exactly what has happened with our health system. The public system is now so disappointing that people are straining daily to spend their own money to break free from it. Most people now have opted out of the NHS for minor ailments, cuts and bruises. The chemist shops are full of customers treating their own allergies, coughs, colds, sores and skin complaints, on advice from the pharmacist.
Some are opting out of conventional medicine for everything from psychiatric problems to back aches, paying for alternative therapies in the private sector. An increasing number of patients are so frustrated with delays and waits in the NHS that they are booking themselves into private clinics and hospitals to have the operation they need. They are often not rich – they cancel the holiday or delay the new car or even sell their home in order to get treatment. Others are taking out private health insurance, with or without the help of their employer, to protect themselves from the long wait if they become ill.
We need to do much better. We need to expand the system rapidly and modernise it dramatically. That will require better use of the public money the government is putting in, and will require much more private money as well. Freeing money from the hotel side would enable us to spend more on the extra nurses and doctors we need to provide the high quality medical care people crave.
We could start by allowing and commissioning new patient hotels. The NHS does not have enough patient beds – successive governments have cut and cut again, as everything has been concentrated in a series of monopoly District General hospitals around the country. New patient hotels would offer people choice. If they wanted to pay they could enjoy a single room rather than having to stay on a dormitory ward. They would be able to hire multi channel TV, computer and internet links, high quality telephony, and an a la carte dining service at times of their choice during the day and evening. If visitors came to see them, they too could buy refreshments in the room. The idea builds on the pay beds and better dining available on a small scale in today's NHS.
People not wanting to pay would then have more chance of gaining a bed in the present ward system, with the present range of facilities, as others opted to pay for the hotel side of their stay in hospital – all would be winners, whether paying or not. All patients would still be entitled to free medical care. The patient hotels would be treated by the expanded nursing and doctor teams that the extra public money should buy. The new private rooms could either be built on existing hospital sites, or new hospitals created around a privately financed patient hotel.
All parts of the hospital, free wards and paying rooms, should also benefit from a wider choice of private paid for service where people want it. Hairdressers, beauticians, a wide variety of retail services should all be available on demand. They should of course be requested by the patient, and be compatible with the prescribed medical regime for that patient, not forced upon the vulnerable by strolling salesmen. A brochure would be given to each new patient setting out what was available on entry, along with any medical instructions that would be relevant.
We could also build public/private partnerships for medical care itself. I was very struck by the courtesy and convenience of the private sector when I had to accompany a patient to an outpatient consultation. We were both offered a coffee on arrival and invited to wait in a comfortable lounge with that day's papers on offer. Within five minutes of the stated appointment time the Consultant himself came out to greet us and apologised for the five minutes delay. I do not recollect that when waiting for over an hour in an NHS outpatients department.
More money could be brought in – and therefore more staff appointed – if we encouraged more insurance. The taxes we pay for the NHS contain both an insurance element for ourselves, and a necessary contribution to the costs of those who need health treatment but are in no position to pay for it. Most of us are ready and willing to pay our contribution to those who need our help, but might be more willing to take out insurance for ourselves if that portion of our tax payment were reduced to help cover the costs of insurance. We are allowed to opt out of part of the State pension provision if we have arranged a better alternative. Let's do the same with health cover.
Given such tax relief the insurance industry would become more inventive and flexible. For many people full scale insurance cover that would protect against any eventuality, however costly, is too dear. Cover against some risks might be affordable and attractive as a proposition. It could be tailored to each person's needs and means. If more of us were able to afford some private treatment we would appreciate more fully what we were missing in the public sector, and increase the pressure for higher standards of patient care.
Most days I now receive letters from constituents describing just how bad things are in the NHS. Some are waiting months to see a consultant, before they can even get on the waiting list for treatment. Some are waiting too long on the list, others find their operation is cancelled just when they thought the waiting was over. Some tell me of torrid conditions in overstretched casualty departments, as too few staff fight bureaucracy and the myriad problems of the waiting patients.
It is going to take big doses of more money, both public and private. It needs more of the little luxuries of the private sector to improve the service and free resources. If we did this in ten years time we could be choosing the hotel part of our health care as we do our holidays – from glossy brochures, promising a little more spoiling.
I am so glad we do not have that National holiday Service – I am sure I would be stuck on a waiting list for the bus seat to connect to the train, let alone getting onto the waiting list for that week in a dormitory in Bournemouth. And did you dare to say you wanted a sea view? Get real – what do you think this is, the private sector?
