Free at the point of use?

…”We must explain the truth; there is no free lunch” Grace Napolitano

LunchWe’ve all heard them haven’t we, free lunch analogies of one sort or another, and I imagine we think we understand them…but when it comes to the National Health Service, we in the UK seem to have a blind-spot. At the moment Twitter is awash with comments from people who feel the NHS is under threat (yes it is, but not from where they think) and they are sharing these comments with us because they want to let us know that they or their loved ones would not be well, or might not even be here, without the NHS. They want to let us know that the NHS is wonderful and that having access to healthcare that is free at the point of use is a fabulous thing. Needless to say these comments are enthusiastically re-tweeted by senior staff from the NHS. But the truth of the matter is this, they and their loved ones were not saved by the loosely managed franchise known as the NHS, they were saved by the availability of some very expensive healthcare that we all paid for, and whilst it might have been free for them to access and use, it most certainly wasn’t free to provide. The NHS has, and will continue to cost taxpayers an awful lot of money…and I would even suggest that a system that allows those who are irresponsible with their own health to have access to healthcare that we have all funded is fundamentally unfair. I believe in the concept of the NHS, a national healthcare system (i.e. consistent nationally) that is free to access and use, but for me that doesn’t mean that someone who knowingly courts a health-risk should occupy a hospital bed that others may need through no fault of their own? In this respect the State has created an irresponsible level of dependency without any sense of personal responsibility…and you and I are paying for it to do so.

My father-in-law was taken ill when he was on holiday in Turkey a few years ago, he was treated well, given good food (take note!) and made comfortable in a well-equipped room of his own in the midst of pleasant good quality surroundings. Before he left the hospital he was given a fully itemised bill that showed him everything he was about to be charged for, at this point you might be tempted to say that this is precisely why the NHS is brilliant, had he fallen ill in the UK he would not have left hospital with a bill; but you’d be wrong…he has worked and consumed for fifty years so he has already paid the bill for healthcare in the UK, its just that he hasn’t used it yet, and importantly may never do so. But the real point of this tale is not who paid for what, the point is that the commercial healthcare provider in Turkey was able to produce an itemised bill, and by doing this they did something that the NHS in the UK can’t or don’t seem able to do, they showed that they had a handle on their costs and that they understood the importance of being able to demonstrate a level of commercial transparency to their customers, their customers insurance companies and their stakeholders. Lets face it, you or I wouldn’t pay our garage bills if they weren’t itemised for us would we, we wouldn’t pay the service bill for a hotel unless it was broken-down by item, so why is that when someone spends a week in a hospital no-one provides them with a summary of what was done and a breakdown of exactly how much it cost and what it was that was paid for? So after more than 65 years existence, why is it that the NHS is unable to produce an itemised bill for each patient that has been treated? If you’d been running a large company in the Private Sector for over 65 years and didn’t yet know what and where your costs were incurred, then quite simply you wouldn’t have been in business for over 65 years.

Its not only in the area of commercial awareness that the NHS is in need of reform, I’m still gob-smacked every time I look at an article in the health-press that espouses the benefits of listening to your patients, as if this was something new and radical…the Chartered Institute of Marketing (est 1911) calls this exciting concept “market research”, the goal of which is to understand the needs of your customers better. Its a damning indictment of the NHS that listening to the needs of those who pay for it and use it, is seen as cutting-edge; still, better late then never…

But of course the NHS is brilliant I hear you say, recent polls by MORI have shown that seven out of ten people in the UK think it is among the best health services in the world. I don’t know about you, but I think this is incredibly poor. This statement might as well read, “we are happy to be mediocre”. Britain is a first world country, it is shocking that only seven out of ten UK residents think it is even “among the best”. I guess the remaining three out of ten must have experienced healthcare in Turkey?

Ah yes that might be so Tom, but you know our healthcare system is one of the most cost effective in the world, numerous studies have shown that it costs less per head to run than many other countries. On the face of it this is an attractive argument, but aside from the obvious quality question about whether you would prefer cheap or good healthcare (Holland has half the hospital death rates of the UK) what it doesn’t take into account is how much we as a nation spend on running and supporting Third Sector support services and how much of an unseen burden we place on Voluntary bodies and organisations like the League of Friends…I can’t help wondering that if the costs of these were factored into the equation then we might yet be shown to have one of the most expensive healthcare systems in the world.

To quote the outgoing Chief Executive of the NHS, the NHS does belong to the people, “its customers”… and they really are customers (albeit without choice?) because in one way or another they are the same people who are paying for it. The question is, are its customers getting the best deal possible for all the money they provide and is the NHS even capable of letting them know?

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