I have many discussions with colleagues about working for the NHS. Many of them are in two minds about it. On the one hand the claim that the NHS is the best deal possible for patients, but they don’t like the stifling bureaucracy that comes with working in the NHS. An example of this stifling and bureaucratic way of doing things is the following. One of my colleagues needed an extension of the memory on his (NHS) laptop. He needed to complete 5 forms and it needed approval of in total 8 managers before it could go to the purchasing department, which subsequently took 4 months to get it done (the 8 managers took 6 months). By that time he had paid for an external hard drive out of his own pocket. So the bureaucracy is overwhelming, but does the NHS offer the best deal for patients? When I dispute this statement, many of my colleagues get really upset and they tell me how beneficial it is to have healthcare that is free at point of delivery and organised in a system like the NHS.
Well here are my reasons for questioning this. First of all is it a good thing that healthcare is free at the point of delivery? My belief is that this is a nice gesture but does not make people value what they get! For example the percentage of clients not attending their sessions in the free psychological therapy centers is far higher (some mention figures of 40%) then in private psychological therapy centers (in the CBT-Partnership the percentage of non-attended appointments is less then 5). I think this says something about the value people allocate to the service they get: if it is free, it does not ‘cost’ anything and therefore results in a very casual attitude to keeping appointments. The other element that votes against free healthcare at the point of delivery is that for the client there is no link between potential health endangering behaviours and finances. In other words, I can continue to lead an unhealthy life style and do not get confronted with the cost to society of my private choices. My preference would be a system whereby only emergency medical services would be freely accessible and for all other medical services each person would get an annual personal budget (and yes, there could be allowances for location and age). Once this budget is spent, that’s it, then the person would need to pay for further interventions themselves. One could think of the option to be able to ‘save up’ money from one year to the next and of course health insurance companies would offer to offer insurance up and above the original allowance. As a smoker, I would then know that my smoking related problems would dig deeply into my health budget and there may be nothing left for other medical problems. People would really think twice before they would visit a GP with a common cold etc.
The other question of course is about the organistion of health delivery. Is a system like the current NHS really the best system. That it is not and that it leads to a cruel and haphazard manner of dealing with patients became once more clear last week. The story is as follows. The patient is a lady in her sixties with serious back pain. She is told that the wait to see a consultant is 18 weeks and decides to see a consultant privately. This consultant deems that an operation is necessary and refers her to the NHS waiting list (the wait is another 18 weeks). After having been on this list for some time she is then told that she has been removed from the list ‘because she has been seen by a private consultant’. And she will only be put back on the waiting list after she has seen the NHS consultant (you guess right, 18 weeks wait). That the consultant she saw privately is the same person as the NHS consultant makes it even more twisted. This is cruel and unfeeling NHS that can condone acts like this. Nick Clegg got my vote when he said that his party would halve the cost of the department of health and would abolish all the regional strategic health authorities. Excellent!!!