HOW long does it take you to make an appointment with your GP? I’m in a fortunate position. I just lift the phone, key in the practice number, speak to reception (who know me by name) and jot down the time and date agreed, always in the same week.
But then, I don’t live in Wokingham, Berkshire, like the unfortunate Edward Lane, a 60-year-old finance director. His attempts to make an appointment on behalf of his elderly deaf mother, who can’t make phone calls and struggles with the online booking form, were met with immense resistance.
Lane still wonders why he had to fight so hard just to get an appointment. He’s not alone. Earlier this month, the Telegraph published an account of the abuse suffered every day by a GP’s secretary – being sworn at, threatened, having to press the panic button – all in the course of having to manage an unmanageable appointments system, whereby patients urgently seeking help hit the brick wall of the NHS’s heavily rationed provision of care. People become so discouraged they are put off seeking medical attention at all. Perhaps, that’s the plan.
It’s all very different to where I now live, in a small village in East Switzerland. Health provision here is insurance based, and while people tend to have a regular moan about how premiums for their ‘Krankenkasse’ keep on rising, they enjoy one of the best healthcare systems in the world.
I am now well into the ‘bonus’ post-70 age group, and require steadily increasing healthcare attention. Unlike their British counterparts, GPs and specialists here consider me not just as a professional responsibility, but as an opportunity. Far from rationing their attention and procedures, they know that treating and caring for people of all ages is the competitive as well as ethical business they’re in, and they welcome everyone, including the elderly, as a valued and valuable source of demand – and, of course, income.
I’ve had a fair amount of experience with local health provision: for example, a hip replacement within eight weeks of referral, comprising a week in hospital, and three weeks in-patient rehabilitation, including a well-appointed fitness gym, a heated therapy pool, and physio training. While insurance covers 90 per cent of costs, the real eye-opener is the itemised bill, listing everything down to the last painkiller. The food served is five star, because nutrition in Switzerland is accepted as a vital part of recovery.
Every provider knows that what they offer has to be high quality and efficient, because patients are able to choose their specialist and hospital.
NHS devotees will argue that where provision is insurance-dependent, those who cannot afford to pay will not get treatment. This is not the case. Health insurance in Switzerland is considered as normal as car or house insurance, but for those genuinely in need, provision is made available from the local authority.
Anyway, what is so egalitarian about the UK system, when those who have to pay dearly for the privilege through general taxation, disguised as ‘national insurance contributions’, face an unacceptable level of rationing, while those who pay nothing into the system have equal access, including all those international health tourists, and even get priority access, in the case of (even illegal) immigrants and so-called asylum seekers? They cost millions, like the outrageous case of a single health tourist in Manchester cost the NHS over £530,000 exemplifies.
Does the NHS’s new boss, Sir Jim Mackey, offer a glimmer of hope for frustrated NHS users? In his first interview since taking on the role, he has stated that the health service makes it really hard for patients to get the care they need. He also admitted that ‘the NHS sees patients as an inconvenience, and has built mechanisms to keep them away’. However, he says that he intends to address the issues.
The 60-million-dollar question is whether the Government’s proposed ten-year health plan will. It promises three major shifts in the way the NHS operates:
- From hospital to community.
- From analogue to digital.
- From treating sickness to prevention.
All policies we have had before, like when they closed mental hospitals for community care! Unless they’re going to reopen local hospitals that every previous administration has closed, it is hard to see this as other than a ruse or, at best, newspeak.
The NHS faces massive challenges with its behemoth of computer systems. Who knows if more digitisation will solve this?
As for ‘from treating sickness to prevention’, we have heard all that before. In plain English, it means vaccination, vaccination, vaccination and medication, medication, medication (i.e. Ozempic). It is not a commitment to making Britian healthy again.
The NHS will receive a record £29billion annual cash injection to help it on its way with this regressive programme, taking its total budget to £232billion by the end of this parliament. Well, thanks a lot, Sir Jim. I’m sure Edward Lane and all the rest of us will be enormously reassured by that…
This is worse than the rearranging of deckchairs. What is desperately needed is to redefine the financial model necessary for a 21st century health service. To function satisfactorily, the NHS will have to start thinking of every patient as a professional opportunity and not a cost centre, and for the patient to start putting a premium on taking care of his or her own health proactively.
The inadequacy of the Government’s ‘promises’ was highlighted by a private orthodontist working under contract to the NHS and paid according to the number of patients he sees. Parents would regularly ask him why his practice was so efficient. He would tell them that most hospital orthodontists saw only a fraction of the patients he did, but were paid a fixed salary regardless of how few they treated. He had to be efficient, otherwise he would go bankrupt.
The NHS doesn’t need more money. It needs doctors to be paid according to their workload and results, and patients need to be free to choose which clinician they see. Of course, this will never happen, especially not under the Starmer government. The current NHS is an ex-Soviet Union type system, which protects itself and doesn’t reward excellence or punish failure. It’s our NHS, and it is more akin to a religion than a working health service.
More than anything, NHS users need to see their healthcare system as a business, not a religion. That would be a first step along the road to constructive reform. They could do a lot worse than attempt to emulate the system I can enjoy here, but I’m not holding my breath.
