Tag: NHS Funding

NHS Dissatisfaction levels are perhaps not yet high enough to embolden the political power elite to further uncouple NHS principles from actual delivery, but they might be going in the right direction.

How satisfied with the NHS are we? The British Social Attitudes Survey has been tracking satisfaction levels since 1983. In 2011 it reached the highest it had been (64%), much higher than the 39% recorded in 2001. In 2000 there was a large rise in funding and according to John Appleby (Kings’ Fund) the change upwards might reflect that extra funding. In 2010 the rate had hit 70%, while in 2015, 65% stated they were quite or very satisfied, with dissatisfaction at a low of 15%. Now, in 2016, dissatisfaction rates have hit a 23% ‘actively dissatisfied’.

 

For trends see the graph at:  http://www.bbc.co.uk/news/health-35527318)

 

 

So, should we read anything into these figures? The “NHS’ is a complex set of organisations and services, and is affected by such external factors such as social care. It is probably foolish to peg changes in attitudes to any one factor (such as funding or waiting times). The survey does provide some information as to why those who are dissatisfied say so:

 

The stand out reason is taking too long to see a GP (60%). Interestingly only less than 5% state ‘stories on TV or radio’. However, 6 reasons above that are also gained by reading the press, watching TV as well as being supplemented by actual experience of friends and family.

See reasons at http://www.bbc.co.uk/news/health-35527318)

 

The figures cannot be directly tracked to funding or political party. The background of the Health and Social Care Act 2012 has not on the face of it made a difference to people’s attitudes. The high rate of satisfaction in 2010 of 70% has dropped to around 60% since, while dissatisfaction has only just started to rise again from the 2011 level.

 

If you want to change the way the NHS is funded, this survey is still an issue. Too many people like it the way it is, “free at the point of delivery” is a possible reason. Social Care (means tested) ranks the lowest on these satisfaction scores and might indicate that funding is a real issue for people.

 

 

The context for this includes 4 assumptions held by governments over the past 25 years: Neena Modi in the Guardian writes:

 

  • Personal responsibility for health supersedes government responsibility.
  • Markets drive efficiency.
  • Universal healthcare is unaffordable.
  • Healthcare is a business.

 

For example, Christopher Smallwood wrote ‘Free at the point of use’ has had its day and argues for private health insurance.

 

Each one of these assumptions are questionable and draw upon a certain view of the role of the state vis a vis the private individual (neoliberalism). Alongside that there are profit making health care organisations looking for new business opportunities that the relatively closed NHS used to block. Graham Scambler’s ‘Greedy Bastards Hypothesis’ suggests that health inequalities are the unintended consequences of the actions of a core cabal of the ‘capitalist executive’ who, aided by the ‘political power elite’ engage in business activities aimed at capital accumulation which includes commercialisation of health services for profit. The Health and Social Care Act 2012 provided an opportunity for just such private sector involvement. A problem for the private sector is that much demand for services comes from an increasingly ageing population whose needs are difficult to make a profit from.

 

 

There are very real discussions to be had about the sort of health service we want and the principles that should underpin it. There is now increasing argument for a rolling back on its founding principles of universal access, comprehensive coverage, equity of service and free at the point of delivery all in the name of ‘affordability’ underpinned by an ideology that deplores public sector provision. Dissatisfaction levels are perhaps not yet high enough to embolden the political power elite to further uncouple NHS principles from actual delivery, but they might be going in the right direction.

 

 

 

For discussion on health services globally see:

 

  1. Which country has the best healthcare system?
  2. Britnall, M (2015) In Search of the Perfect Health System. Palgrave macmillan .

 

 

 

 

 

NHS Funding – Calls to introduce charges

The Kings Fund have been looking at the future of the NHS and how it will be funded. One of those invited to discuss the issue with Kings is the right wing think tank ‘Reform‘.
Roy Lilley stated that Professor Alan Maynard tweeted about Reform’s message to King’s:
Alan Maynard (@ProfAlanMaynard)   25/08/2014 04:35 pm
NHS funding: “can we ignore pricing any longer” in KF weekly bulletin. Answer: YES! Taxation is fairer, easier to collect & opposed by cretins!!
King’s concern is about the issue of  demand for health services outstripping the country’s ability to pay. The suggestion is that the  NHS is facing a funding crisis so big that that the only solution is co-payments, top ups and insurance. This challenges the NHS principle of ‘free at the point of delivery’. I have argued in a previous post that care costs and so we have to consider who pays, but my view is that we should socialise the risk and spread the cost across society.
Roy Lilley asks: “Are top-up or insurance based systems with their overheads, actuarial hocus-pocus, running costs, surpluses, cost of collections, regulations, appeals systems and palaver cheaper and more efficient than a tax based system?”
He goes onto make the point that insurers “have to lay-off risk, reduce exposure and break even on their book. And, ten pounds to see a GP is £10 that has to be collected, administered, audited and in extremis, debt-collected. Taxes must be cheaper to administer and easier to collect”.
Kings,  in listening to Reform , are lending credence to the neoliberal dogma that wishes to shrink the state, individualise costs and encouraging private sector involvement.
The Tories used to say that the NHS is safe in their hands. The Kings bulletin will be music to their ears. Don’t expect Miliband’s Labour to challenge this.
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