The NHS: Adapt or Die

This morning’s news that the Red Cross has been sending volunteers to help the UK’s NHS through a “humanitarian crisis” this winter, is truly disturbing. Amidst all the finger pointing and blame throwing, there seems to be a real lack of both understanding just where the problem lies and how to fix it.

Although I am British, I live in Belgium, and have done for over eighteen years now. Here, there is no NHS. We pay for healthcare. What there is, however, is what is known as “mutualiteit” or “mutuality” – basically a health insurance scheme. Without this scheme, healthcare would be outrageously expensive, running into the thousands of euros for a day or so stay in hospital, for example. With the health insurance scheme, healthcare is far more affordable. I cannot speak for every Belgian family’s situation, but I can speak for my own.

My husband and I pay €80 (approximately £68 at the time of writing) per year for our health insurance. That covers both of us. With this policy, we still have to pay for our healthcare, but the bills are shared between us and the insurance company, with the insurance company picking up two-thirds of the bill (more if you are unemployed or signed off from work due to a chronic condition). So, for example, let’s say I have to go and see my GP. A consultation will cost me €10 (£8.50). It is the same price whether the consultation lasts for five minutes or forty-five minutes. And there is no in-and-out-and-here’s-your-prescription. Oh no! Whenever I have had to see my GP, the average length of time that I am in a consultation is around twenty minutes.

Similarly, if we have to have a hospital visit, let’s say. The last time my husband was in hospital, he was admitted as an emergency after having difficulty breathing due to a severe chest infection. He was in hospital for a day and a half, at which time his bill came to €476 (£408) of which he had to pay €79.33 (£68).

Another example. A few years ago, my husband had to see our GP because he was having stomach problems. The GP suspected that he had a stomach ulcer, and so wrote a letter to a gastroenterologist, listing his symptoms and asking him to perform an endoscopy. We called the clinic and made an appointment with the gastroenterologist for the following day. The endoscopy confirmed that he had a stomach ulcer, at which time the gastroenterologist wrote a prescription for suitable medication and that was that. A visit to the GP, a consultation with a specialist, an endoscopy and prescription medication in 24 hours. All that cost €78 (£66).

There are many other examples of which I could cite, including a treatise on waiting times (the longest time we’ve had to wait was two months and that was for admittance to a sleep clinic), but for the sake of brevity I shall refrain. However, the last example about the the gastroenterologist brings me onto another difference between the Belgian health service and the NHS. Whilst it is possible to have scans and X-rays at hospital as an outpatient (as a patient you are free to choose where you wish to be treated and can even specify which doctor you prefer), the vast majority of such appointments take place at external clinics. For example, there are clinics which only do scans (such as ultrasounds, mammograms, bone density scans etc), clinics which deal in heart conditions (the placement of halters to check the heart rhythm over 24 hours, heart scans, ECG’s etc) and ones where endoscopies, colonoscopies and the like are performed. This leaves those hospital departments free for those patients actually in hospital. Compare that to the NHS, where frustrations often boil over when patients are forced to quite rightly wait while those most seriously ill are treated. It cuts down on waiting times too. The more patients a department has to see, the longer the wait. There are, after all, only so many hours in a day.

All of what I have said thus far may come across as me being down on the NHS. Not so. Indeed, where it not for the NHS, neither I nor my brother and sisters would be here (my mother had a lifesaving heart operation on the NHS, at its birth in fact, in 1948). I am not down on the NHS at all, but what I am is realistic. At the dawn of the NHS, the UK population stood at a shade over 50 million. Today it is 65.3 million and is expected to reach 70 million by 2029. It is an untenable situation.

I understand that a great many members of the public, as well as in the government, will dig in their heels and shout and scream at any notion of charging for healthcare, but to my mind, that is nothing but sentimentality, and sentiment doesn’t often solve a problem. If the British people love the NHS, they have to realise that love does not always speak kindly. Love does not always mollycoddle. Love speaks the truth, no matter how tough to say or hear that truth will be. Therefore, love of the NHS needs to change from sentimental love to tough love.

And one element of that tough love must be the introduction of a Belgian-style health insurance system, allowing UK citizens to contribute towards their healthcare. Under that scheme, if you are unemployed or signed off work, naturally you contribute less than those who are gainfully employed, but you still contribute something. This would then allow those at the bottom of the societal heap, the homeless and destitute for example, to still be treated free of charge, and once they are back on their feet, they once again contribute.

Another element of tough love has to be the elimination of health migration and health tourism. If someone wishes to come to Britain and, at any point during their residence in the country they should fall ill, have an accident, or need healthcare for whatever reason, they must ensure that they have the capacity to either meet their own treatment costs or have their own health insurance.

My sister is a nurse within the NHS, and has been for over thirty years (I’ve written about her before in my post A Bowl of False Teeth), and from what she has told me and what I have seen of her job, the NHS has a chronic case of too many chiefs and not enough Indians. By that I mean that there are too many hospital managers and too few nurses. Don’t believe me? Between 1999 and 2009 the total number of NHS staff increased by 35%, while the total number of managers and senior managers increased by 82% during the same period. In 2015, a hospital chief executive could expect to earn around £172,000, substantially more than the Prime Minister! A Medical Director earns around £142,000. Meanwhile, an entry level nurse earns just over £21,000. Just by removing one Medical Director from one hospital, the NHS could fund the recruitment of six entry level nurses. That’s just one director at one hospital. Remove one senior health service manager at one hospital and you could fund the recruitment of a further four nurses. One hospital which I looked at for this piece had eighteen clinical directors, three of whom were apparently responsible for the same department. Food for thought.

The NHS needs to move into the 21st century too. Here in Belgium, the healthcare system has a centralised database, meaning that if I go to hospital, they can immediately look at my health records and thus get an overview of my health history. Similarly, if I visited my GP after visiting A&E for example, my GP would be able to see that I had been there and why. In the NHS, GPs are still writing to specialists by letter! The last time my mother went to an outpatient clinic, the doctor had to send someone to physically bring her cardboard file from three doors down the corridor. The technology is there for god’s sake…use it!

I am not for one moment suggesting that I am some Donald Trump figure and that I alone have the answers to solve all problems. What I am suggesting though, is that the NHS needs to look at how other countries, such as Belgium, successfully manage their health systems and cherry pick the ideas that work best. The NHS must adapt to the rapidly changing society. If it fails to do so, I’m afraid the prognosis is bleak.

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