The NHS is not a religion it is one of Europe’s largest employers and one of its biggest enterprises. As such it demands the highest standards of management, not least financial management. The welfare model is robust – healthcare funded out of general taxation with the sick not being penalised if they are poor. But as taxpayers it is reasonable for us to ask that the Service is run efficiently.
Efficiency is about standards and about meeting those standards at least cost. You cannot talk about the “NHS Budget” without simultaneously talking about what it delivers. For example, what is the target waiting time for operations where the patient’s condition is not life-threatening? How long should a patient have to wait in A&E before being seen. What are criteria for prescriptions if the medication is of very high cost?
There are judgment calls along the way. To facilitate decision-making openness is essential. Here subsidiarity – taking a decision at the lowest practicable level – is important. It seems logical that this be at the patient’s interface with their GP. Larger GP practices and/or grouping of GPs together so that they become much wider in the scope of what they do should be the norm. If each GP has a speciality that could ensure that a patient’s symptoms get early attention rather than delay from referral to a hospital or specialist.
Healthcare is often described in ideological terms. The Free Market versus socialised medical services. This will always be unhelpful. There is no better example of the mixed economy than the NHS. The State working had in hand with the private sector to deliver an efficient and integrated service. Obviously on the margin decisions need to be made about whether an activity should be contracted out rather than carried out by NHS employees. Again, standards and efficiency are paramount. Expressed perhaps over-simply one can say that the standards need to be agreed and then decisions made about the best way to meet those standards and the appropriate mix of public and private sector staff involved.
Costly though it is the NHS compares favourably with other countries. Of the G7 group of large, developed economies, UK healthcare spending per person (£2,989 in 2017) was the second lowest, with the highest spenders being France (£3,737), Germany (£4,432) and the United States (£7,736). Obviously, this does not necessarily compare like with like and the delivered standards may not be comparable. But it is a myth that the British system is profligate.
A debate on Healthcare is welcome not least because it is clear what we do now is sub-optimum. We may need to spend more; we certainly need to spend better. What we don’t need is to make the Health Service a battleground and ideology wars.