The future of the NHS will be high on political party agendas as the UK approaches its next general election. Lucy Quinton explores how the public and private sectors could function in unison.
While the UK seems to be inundated to saturation point with every minutiae of the American election fever, there will be little respite for the British population over the next year as general election frenzy is also set to hit the UK.
Under the guidelines of the Parliament Acts of 1911 and 1949 the next UK general election must be held before 3 June 2010, barring exceptional circumstances. If the current Parliament follows the pattern of dissolution after four years, the next general election will occur in 2009.
The three main political parties remain unstintingly loyal to a future commitment of the NHS (see boxes). This could mean the private sector being sidelined once again.
Improving the NHS is always bandied around at election time by politicians because it is seen as a vote winner, yet while politicians may remain loyal to the NHS, it looks increasingly likely that at some point they will have to consider sharing risk with the private sector to meet demand.
Stephen Walker, chief executive of Medical Insurance Services, explains: "The problem that everyone knows about is that a relationship with the private sector would work but would be political suicide."
To date though, little has changed as Peter Staddon, head of technical services at the British Insurance Brokers' Association (Biba), agrees: "An NHS will probably be kept for many years to come, virtually indefinitely, as no political party would wish to be associated with its demise."
Paul Bridges, director of healthcare at Ainsbury, also concurs: "As the continued investment in the NHS by Government is such an emotive subject to the voting public, no political party is likely to take the risk of alienating voters by doing anything other than pledging continued support and increased investment."
However, he believes that if the Government recognises the role that medical insurance can play in reducing the demands on the NHS it could be on to a winner.
The significant growth in additional funding which the NHS has received since 2002 will slow after 2008. The result will be an inevitable gap between demand for public healthcare and an insufficient budget to provide it, claims Fiona Harris, head of personal markets at Bupa. Back in 2006, Bupa's Mind the Gap report predicted there would be a funding shortfall of £11bn by 2015 for UK healthcare.
Perhaps what is more worrying is that a few months ago, Derek Wanless' report for the King's Fund put the figure by 2010 closer to £15bn.
The idea of a tie-up between the two sectors is often mooted in the industry partly fuelled by the fact that sales of private medical insurance (PMI) are at an all time low and worse than anticipated. Staddon explains one reason for this as: "The proposition of PMI can be quite unattractive, large premiums, restricted choice, medical exclusions and poor service standards from the industry mean that many considering the options would be inclined to 'take the risk' with the NHS."
Better alone
However, there are stalwarts within the PMI sector who, even though sales are down, would not even consider a relationship between the sectors. Alistair Sclare, head of healthcare underwriting at Groupama Healthcare, says the relationship is not something the firm would contemplate. "There are statements frequently regurgitated about how the future looks bleak but we believe the market will be there for a while. We are not competing with the NHS, but focusing on the provision of PMI."
While this may be the case, the last 10 years has shown people that throwing money at a problem does not necessarily bring about an improvement in standards.
It is often argued that giving consumers a choice of going private would alleviate pressure on an overburdened NHS and hopefully elevate standards. Jonathan French, spokesperson for the Association of British Insurers, says: "There is a growing political consensus around the importance of choice in the provision of healthcare, and PMI has a big part to play in taking this agenda forward."
Some recent policy ruminations could also play into the private sector hands, for example, recent speculation that the NHS would consider withholding treatment from certain undeserving people -such as smokers and the obese - could ensure PMI has a role to play in the future .
The private sector can also benefit from changing corporate responsibilities as it can enable companies to take more care of their employees and meet some of their duties of care requirements. However, Bridges says this will take real effort from the insurers and intermediaries in addition to the Government when it comes to educating employers and perhaps further incentivising them with tax breaks.
However, as Bridges explains, unless there is a specific shift by the Government to really encourage employers to invest more in their employees' health and welfare, the market will remain fairly flat and stagnant.
Walker says that there should also be more focus on dental care. This is something that has been chipped away from the original NHS ideology. Reports have shown a distinct lack of NHS dentists which has left many people stranded. This is where the PMI industry can exploit NHS failings for its own gain. "More thought to what role private dental insurance can play should be on the cards," Walker says.
French agrees PMI has a big role to play in driving forward the choice agenda in healthcare provision, contributing to the debate on the availability and viability of treatments and drugs and helping drive up standards across the UK healthcare system.
Attitudes towards healthcare are changing with people wanting more control over healthcare options rather than leaving it to chance.
It may be true then that PMI could alleviate pressure on the NHS but the industry itself must buck up its offering to different core markets.
Providers, for their part, are looking at various ways of making products more flexible, including making them modular to help consumers pick and choose the appropriate level.
Staddon agrees that providers can and must do more: "Basically, a product tailored to fit with the policyholders' lifestyle, their requirements and wishes is needed. It is invaluable if providers can wake up to the fact that they should be promoting 'wellness' or 'preventative health'."
Harris agrees with Staddon on this point, reiterating that preventative healthcare will become increasingly central to Britain's health insurance industry, which is moving more and more into the 'positive health' territory rather than simply addressing illness.
To develop this, more PMI providers are offering benefits as part of their packages. Harris says that more incentives need to be offered to businesses to encourage healthy behaviours and good practice in the workplace.
CONSUMER DEMAND
In order to keep up with consumers' fast paced lifestyles, technology needs to evolve too. Information via platforms such as the internet is already largely available to a certain extent. There are vast quantities of websites that cater for consumers wanting to find out general health information. But what needs to happen next is a further evolution where clinical outcome measures and service comparisons are available, giving consumers the tools they need to make informed choices about treatment options. "This is only likely to increase the demand for supplementing NHS care with privately-funded choice," Harris says.
In order to ensure the private sector does not miss the opportunity to work in conjunction with the NHS - in terms of priority of what providers should be focusing on - service, innovation and price are all key. Staddon says in the immediate future some insurers need to improve their administrative skills because despite the Financial Services Authority's ethos of treating customers fairly, some firms are consistently failing to meet basic standards which gives the industry a bad name. He adds that there seems too much focus on acquiring new business and not enough on looking after their existing client base.
What comes across though, is that come what may after a general election, PMI will have a growing place in the future. "It is clear attitudes to personal healthcare are changing with people keen to have more control over their options rather than leaving it to chance. People want to know for example that they won't have to wait for treatment and that they will be treated in clean hospitals," surmises Harris.
However, if there is to be a working relationship between the two sectors then PMI providers need to play their part and ensure there is better consumer understanding about cover options on the private side. Providers should also be at the forefront of trying to drive up healthcare standards, ensuring they are proactive rather than reactive. This working relationship extends to liaising with the Government in attempting to improve the overall health of the working population, in addition to actively engaging in healthcare debates. n
