My blog was recently described as “…angry…” I was a little taken aback, but in truth it is a fair assessment of my tone and feelings when I write. There are lots of things I’m angry about, things on a personal level and things on a political level but as any old school feminist will tell you the personal is political so lets have at it (I added that last bit)
Today my attention turns to the NHS.
…the health service will be available to all and financed entirely from taxation, which means that people pay into it according to their means.
The NHS was created out of the ideal that good healthcare should be available to all, regardless of wealth. When it was launched by the then minister of health, Aneurin Bevan, on July 5 1948, it was based on three core principles:
- that it meet the needs of everyone
- that it be free at the point of delivery
- that it be based on clinical need, not ability to pay
These three principles have guided the development of the NHS over more than 60 years and remain at its core.
Sadly, while these core principles may guide the development of the NHS and its staff, they don’t seem to apply to the ministers who make decisions about how to fund the NHS.
Have you met Andrew Lansley? He’s the fellow in charge of the health budget, think of him as the middle man between you and the doctor, a kind of parliamentary health pimp. The reason he has caught my eye today was this piece in the New Statesman – Lansley opens door for full scale NHS privatisation.
Please read and take the time to note the correction at the top of the page, but I’m going to rant anyway.
Now, lets go back to that third core principle: That it be based on clinical need, not ability to pay.
I’ve made it bold so it sticks in your head a bit more – maybe someone should print it out and stick it to the front of Mr. Lansley’s homework book.
So here’s my question:
How does ANY service provider that offers not-for-profit and for-profit services manage to deliver both services equitably to its users?
Put it this way – if I take my child to see a doctor for a case of tonsilitis and I’m an NHS patient and another child, equally poorly but a private patient is there, how will the surgery decide who to prioritise? In the private sector companies prioritise the services or goods that make the biggest profit for them. In the not-for-profit sector organisations prioritise services that the meet needs of their users (this is of course an over-simplification).
How, when a healthcare provider has to demonstrate profitability and effectiveness measured in all kinds of metrics other than nebulous notion of care, will they manage NOT to include “ability to pay” as a way to decide the priority of care.
In my example above it would, arguably, be acceptable to look at two equally poorly patients and decide that the patient that can contribute to the financial running of the service will be prioritised over someone that doesn’t.
If healthcare provision goes in favour of ability to pay over clinical need it will impact those most in need of help and with limited resources. Not just the poorest of the poor – it will have an impact through the social scale until you get to the those people that have that rarest of things now “disposable income”.
If the NHS services become more costly and out prices people from accessing services, those services could be deemed as “not needed” based on a low usage and therefore abolished. Could we see communities without Drs’ surgeries or hospitals because they weren’t needed because they were too expensive to be used?
Is this fair – well that depends on your definition of fair. Is it equitable, not that I can see. Does it meet with the third core principle of the NHS? I’ll leave you to decide.