"The NHS is struggling to cope", and the "root of the problem is not the world-class doctors, nurses or even managers who work in the NHS, but the system that they are working in" says James Gubb.
The failings of the NHS: the inequalities, inefficiency, funding gaps, unhealthy outcomes and insufficient reform of the ‘demand’ side of the service are well described.
The blame is largely directed towards central Government control and resource allocation. The proposed solution is to look to Europe and in particular social insurance schemes linked to decentralised, competitive and patient-led health care. Implementation of such a system in the Netherlands in 2006 has transformed it into one of the most streamlined, equitable and competitive in the world.
My own thoughts are that too much of this article was devoted to the shortcomings of the NHS which are already well recognised. In addition Gubb omits to mention the growth of co-payments which also contribute towards the inequity of healthcare provision.
I agree that adoption of a social insurance scheme combined with opening up healthcare provision to multiple providers is the way forward for solving many of the problems of the NHS, but I would have liked Gubb to take the matter further and discussed the political hurdles which would be faced by the major political parties in implementing such a system. At present I do not think this country is ready; the public are not sufficiently dissatisfied by the NHS, consider that too many reorganisations have occurred, and there would be objections from pensioners who have paid taxes throughout their working life. Furthermore it would be political suicide for the major parties who have continued to promote the NHS as being free at the point of delivery. However it is only a matter of time before a future government will be forced to adopt such a scheme faced with ever spiralling costs and on-going waiting lists. Starting the debate now will help to develop the ideas further and prepare the country for what is to come.
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18/03/2008
The PDF of the CIVITAS review. |
Andrew Burns, 2020health
