Health debate should address citizens’ own responsibility to the NHS

With NHS performance slipping to its lowest levels since the 1990s and provider finances a deep concern, Political Consultant Peter Shand calls for policy makers to begin a real conversation with the public as to the future of the NHS.

The King’s Fund’s assessment of NHS performance published this morning emphasised the bleak financial picture facing the NHS in the coming years with providers facing record deficits. Coupled to this recent efficiencies that have met the 2010 ‘Nicholson challenge’ have predominantly been found in reducing prices paid for services and continued freezes on staff pay, an unsustainable solution and one which is beginning to have knock-on consequences of declining performance and staff morale.

This begs a question – if we’re so happy to shift around deckchairs, continually talk about integration of health and social care and espouse new care models (however laudable NHS England’s progress through the Five Year Forward View has been on the latter) why aren’t we happy to talk to the public about the fundamental principles of the NHS?

The is due to short-termism from politicians who believe that the best way to defend (rather than gain) votes from the NHS is to make sure that they are seen as the best guardians of what has been termed ‘the closest thing Brits have to a national religion’. Whilst this isn’t necessarily a ground-breaking conclusion, it does get to the heart of why Whitehall policy-makers are happy to have grandiose projects related to care models reform but not a debate with the public about the individuals own responsibility to the NHS, believing that this will cost them votes.

Britons know that the health service, as great an institution as it is, cannot survive in its current form and tough decisions over spending still remain. Many would be open to an honest discussion with politicians about their own obligations to the health service and different options on the table for reform. Being frank, I am talking about NHS charges. Whilst I wouldn’t advocate flat fees for NHS care as this removes the equality in the system that is the envy of the world. Polling conducted by the Whitehouse Consultancy  has also only found lukewarm support for charges to gateway services such as primary care.

Instead, why not start with charges for missed GP and outpatient appointments. With record numbers of patients complaining that they can’t get a GP appointment not only would this free up vital slots for other patients but also bring in additional revenue (the Reform think tank has estimated around £700 million). This could then be spent on preparing primary and community care for the shift away from hospital services. And for those people that complain such a system is unfair, we are already willing to impose conditionality on welfare claimants and should be prepared to do so for other universal services provided by the state.

This will only provide for a small percentage of the £8 billion annual uplift needed to ensure the NHS continues to provide high quality care through the next five years. However without a first step towards reframing our own responsibility to the NHS we cannot even begin to ask deeper questions about what we want the NHS to do for us in the future.

For an in-depth look at how the main parties are approaching the NHS at the election, see our recent insider’s guide to the health service available here.