In July last year, Alan Milburn announced the NHS Plan, the Government's vision for a 21st century h...
In July last year, Alan Milburn announced the NHS Plan, the Government's vision for a 21st century health service. The launch should herald a huge step forward for the provision of healthcare in the UK. However, what will determine the success of the Government's long-term strategy is how the NHS works with health professionals and private partners to improve the efficiency of the existing system, and to agree the funding of the new system to meet the growing demands placed on it.
The World Health Report published last summer made it clear that the UK is facing an uphill task. The measure of efficiency, defined as how effectively funding on healthcare is used, showed Britain in 18th position, well behind France, Italy and Spain.
A future plan for the NHS
So, can we be encouraged by a plan that outlines the Government's vision for an NHS that provides 'fast and convenient care delivered to a consistently high standard'? Certainly the plan has set an ambitious agenda for the NHS over the next few years. If the Government's aims are met, by 2005 there will be an additional 20,000 nurses, 7,500 consultants and 2,000 GPs. By the same time, the maximum waiting time for an outpatient appointment will be three months, and for an inpatient appointment, six months. Few would doubt that to meet these stretching targets the Government will need to call on help from the private sector.
It is recognised that the challenge is to use the resources that have been made available to achieve real benefits for patients and that this is made more challenging by increasing demands and rising expectations. Tony Blair has set five areas to address in order to tackle this challenge. These are partnership, performance, professions and the wider NHS workforce, patient care and prevention.
Using partnerships
But it is the first of these areas, partnership, that is crucial to the success of the NHS Plan. In fact, it could be argued that all areas will be more effectively approached and delivered through the use of partnerships.
The partnership between public and private sectors has been advocated by those in the private sector for some years, and we have been heartened by the successful introduction of the NHS concordat with private hospitals. It may be too early to tell the impact of the concordat on waiting lists but it is this kind of initiative that is needed to help the NHS start meeting public demand. The public sector should not be expected to work alone.
Public support for true partnership is not in doubt. Findings of a recent consumer survey show that the public endorses a co-operative approach. Working more closely with the private sector was by far the most favoured approach to averting NHS crises. When asked which areas of healthcare the private sector could improve, nearly three-quarters believe that waiting times for treatments and operations could be improved. Two thirds believe that co-operation could help the NHS in meeting the Government's targets relating to the treatment of heart problems, cancer and other serious conditions. Most significantly, only 4% say that such partnerships would not benefit the NHS in any of the areas suggested by the survey.
There are many ways that the Government and the private sector can work together. One of the next areas that should be considered is the sharing of clinical data to ensure that information is pooled. This will ensure that the most effective treatments are provided. Public and private sectors should not compete at the expense of the patient, but build a trusting relationship from which everyone will benefit.
These partnerships need not be isolated to private hospital providers. Another key factor to the success of the NHS Plan will be the funding of increased demand from the public. As technological advances lead to the treatments and procedures to cure more conditions more effectively, costs will rise. In addition, as the patient becomes more aware of health issues and more informed about the choices available, there are greater expectations about what should be made available to them.
While welcoming the concept of the NHS Plan, one concern is how much the growing public demand has been accounted for. The plan itself acknowledges that demand is increasing. Compared with 1997 there are over 500,000 more operations a year, 400,000 more patients are being seen as first outpatient appointments and 300,000 more emergencies are being dealt with every year. What is not clear is whether the requirements for 2005 have been projected in the additional resources that have been targeted.
Innovating PMI
Proposals for alternative funding have been chronicled over the past few years. These include the development of more flexible insurance products, shared risk products and a welfare Isa that would allow people to save for healthcare, long term care and periods off work tax free.
Some progress has been made in the area of shared risk. Last year saw the introduction of a new generation of insurance products that encourage the consumer to share the risk of private treatment with the insurer by taking out a high excess. These are the forerunners of increasingly flexible products that will increase the PMI market and ease the pressure on the NHS.
Providers are now looking at ways of reducing the cost of PMI to ensure customers can continue their policies, without reducing their benefits. Along with the new generation of products, providers have been looking at ways of increasing efficiency and reducing cost base by negotiating more keenly with hospital groups.
However, what is required is more open dialogue with the Government to explore how new products can be developed to meet the growing healthcare needs of consumers. It should be clear that we do not advocate the end of a universal healthcare service based on clinical need, rather than ability to pay. Nevertheless, we have to recognise that the public has the right to expect access to the latest treatments and that despite the increase in funding, the current system does not facilitate this.
The aforementioned research demonstrates that the public is aware of this. The majority of respondents were clear that the NHS cannot realistically continue to provide free treatment for every condition and therapy, given the vast number of new drugs and treatments that have been discovered over the past 50 years.
The Government tells us that the National Institute for Clinical Excellence (NICE) is approving more new drugs, and has recently announced its approval for new treatments for leukemia and ovarian cancer among others. However, the issue of cost is always at the centre of any decision and it is this that needs to be tackled head-on.
An inquiry led by the British Medical Authority (BMA) recently concluded recently that rationing may be common place in the future. Ian Bogle, chairman of the BMA, has said that we have to accept the prospect of treatments being excluded from the NHS if we want to maintain a universal service that is free at point of use.
It is inevitable that the debate over healthcare will dominate the lead up to the General Election. Whether the Government wins a new term of office, or we have a change of government, the victor will need to demonstrate a long-term commitment to working with the private sector if it is to meet its objectives. It is through partnership that we can deliver a world-class 21st century health service.
Mike Hall is managing director of Standard Life Healthcare
