Wednesday, 24 July 2013

The slow death of the NHS

Since I came to this country in 1992, the NHS has been in perpetual crisis. First, it was long waiting times, then poor cancer care and treatment outcomes with unusually high death rates, and finally, it was people unnecessarily dying in hospitals.

The answer of politicians is to throw more money at the NHS in a desperate attempt to shore up its capacities to deal with chronic diseases, long term illnesses and complex health problems of an aging population. But the real culprit in the demise of the NHS is a fundamental change in the health care needs of people and the huge financial burdens of medicine developments.

As the body for vaccine licensing in the UK published its latest shocking report, it has become clear that a tax based health care sector is creaking at the seams and is becoming untenable fast. The development of medicines has traditionally been the domain of the pharmaceutical industry, but something significant has happened over the last decade. As diseases became ever more difficult to analyse and combat, medicine development has become ever more costly. Developing an effective vaccine can easily take 20 years and cost 100 million pounds as the various substances are tested and go through a plethora of trials to improve their composition and ensure their safety.

These are enormous entrepreneurial risks and practically no company can take these risks on their own today. So, governments have stepped in and underwritten some of the financing risks of some vaccine developments. While that means broader shoulders for the risks, the costs can be devastating for the health sector as not all vaccine developments are successful.

What does that have to do with the NHS? Spiraling costs in medicine development and care delivery mean that the NHS will always fall short of caring adequately for everyone. And that has been the principle of the NHS since its inception: ration the care to those most at need. Yet, the latest decision of the Department of Health clearly shows it is not the most vulnerable who benefit from the rationing principle. What guides bureaucrats in Whitehall is a lifeless formula which decides who lives and who dies in the NHS.

This problem wont go away. In fact, it will get worse unless the government will find new sources for significant investment in the health sector. There seems to be only one answer. Open the NHS up to insurance based services. It would provide a new income for the NHS and would allow patients to decide how much they want to pay for the care they think they need.

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