PROFESSOR STEPHEN SMITH writes why we should start thinking about the future of the NHS –

We need to talk about “our” SSN. It is clear that it is at a breaking point and will need radical reforms to survive. Yet whoever dares to say it risks hysteria.

Hospitals in England are very inadequate. A report by the Commons Committee on Health and Social Care this week revealed that we need 12,000 additional doctors and more than 50,000 nurses and midwives.

By the early 1930s, the NHS is expected to require an additional 475,000 workers and an additional 490,000 jobs for assistants.

But these services are already under great pressure. Last year, one in three caregivers retired and the number of full-time GPs has decreased by more than 700 since 2019, many of whom are now only working part-time. The average waiting time for the ambulance is not less than 51 minutes.

Yesterday’s post contained the gruesome tale of a 61-year-old heart patient, himself a retired doctor. Her husband drove her about 300 miles from Cornwall to London after she had chest pains.

Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College.

anger

We cannot go on like this. In the wake of the pandemic and its impact on healthcare, the UK has a record population of 6.6 million on NHS waiting lists, and that number is growing. This is unsustainable and we have to face it.

But how? Frankly, any attempt at dialogue about the future of the NHS should be met with anger and panic by those who view it as blasphemy, even considering alternative ways to finance the system, it is utterly unhelpful.

These people claim to be defending “our NHS” by refusing to accept change and instead insisting that any problem can be solved with “more money”. But perhaps ironically, with this condition, they could limit our healthcare system to death.

If we could have an open discussion about the alternatives out there, people would understand that the status quo might not be the best option. There are several internationally recognized alternatives that can help us. One I’ve covered in a new book published this week by the Radix UK think tank could be the “hotel cost” for hospital admissions, as with the German and French models, where patients charge a nominal fee (around £8 per night). ) pay for a bed.

I have advocated this not as a policy in itself, but as one of many options that we can consider as a starting point for discussion. However, it was met with anger in some quarters. It’s almost unpatriotic in some ways to state that many developed countries have in some ways superior healthcare to ours: more efficient waiting lists, shorter waiting lists, more beds, better outcomes for cancer and other diseases.

By the early 1930s, the NHS is expected to need 475,000 more workers and 490,000 more jobs for assistants.

But we have to face the facts. The NHS is almost 75 years old. All this time it has been centrally funded by taxes, and no matter how much money is invested in the service, it is never enough.

Every other aspect of life in Britain has changed dramatically in these seventy years. There is no point in continuing our panting elderly health care for life support.

But let me make one thing clear: Regardless of the new financing models we incorporate, we can never accept the US system of lower-income individual health insurance policies. No country should suffer from this. It is also true that there is no perfect healthcare system anywhere in the world. All of them have pros and cons.

A simple method would be to collect a hypothetical fee to raise funds specifically for the NHS.

Jeremy Hunt took this into account when he was health minister and proposed a 10-year financing plan that included tax increases for older workers.

Another idea was to collect national insurance benefits from the 1.2 million retirees who continue to work beyond retirement age. Neither program would be very popular with people who have already paid taxes for their entire working life, as is the proposal to eliminate universal free prescriptions for people over 60.

The chart shows NHS England’s waiting list for routine surgeries such as hip and knee surgeries (red line), which set a record 6.18 million in February of this year.

In April of this year, all employees began paying the Health and Social Care Tax, a 1.25% increase in NI payments to help manage our social care crisis. But the outline of such money has never been disclosed, and they are said to be going to clean up the Covid-related savings for this year. How far money will find its way to social welfare is a mystery.

In fact, the real problem with the allocation of certain taxes is that governments always tend to plunder them for other, more pressing purposes.

We need to be more creative. We are an infinitely resourceful and innovative country. Healing the NHS should not go beyond our collective strengths.

For example, we can increase the number of additional costs, such as the costs we already pay for prescriptions and dentistry.

These benefits can then be proof of income and reimbursed to people with lower incomes. Elderly or long-term patients may also be excluded so that any additional costs can only be borne by those who can actually afford it.

Busy

I think this would be much more popular than a general tax increase. And most importantly, we know it can work because it’s already common in Europe.

Numbers show how NHS bed occupancy has changed during the pandemic

The French pay a similar fee to see a doctor. This deters those who waste time with pointless complaints, reduces the pressure on doctors and frees up more appointments. And frankly, the fee is reimbursed to those who can afford less.

I would expect 90% of patients to be eligible for reimbursement, as only 10% of people who get a prescription in the UK should actually pay. The vast majority are exempt.

Sometimes an advanced counter-argument is that successful cancer treatment often relies on early detection, and anything that makes people less likely to get tested is dangerous, such as paying upfront to see a doctor. But the numbers show that cancer outcomes in France are actually better than in the UK.

The French and Germans also have far better acute care hospital beds than we do. But the Scandinavian countries do not, and their healthcare is often considered the best in the world.

Sweden and other Scandinavian countries have excellent social care services that allow them to avoid many problems before hospitalization. But everything has a price, and Scandinavians pay a lot more taxes than we do.

inhuman

At the height of the epidemic, Britain seemed to finally realize a crucial factor: the role of our excellent medical staff. Doctors, nurses, and other healthcare professionals perform some of the most difficult tasks imaginable. It makes sense to reduce the tension and pressure in their lives as much as possible.

If we don’t, many will give up tired or disappointed as they already do. The GP treadmill, which has to inspect every eight minutes, every hour, is inhumane. It takes up to 15 years to train a doctor. Anyone leaving the NHS is a serious loss.

We can’t keep shouting “I love the NHS” and hope only love will make it. This week’s cross report is a step forward. But if it is to have any real impact, it must spark an honest, emotionless discussion about the future.

People may disagree and fight for what they think is the best way. After all, there is no single answer to the crisis in the NHS. But one thing is for sure: the system is crashing, and blindly throwing money at it won’t fix it.

• Professor Stephen Smith is the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine at Imperial College.