The news outlets are once again busy reporting the pressures faced by the National Health Service and are apportioning blame. Last year, as it does every year, demand for NHS services spiked during the winter months, and the cracks in the system became more prominent. This naturally led to the political claim set out by opposition that the NHS is not safe under a Conservative administration – that our purpose is to attack and dismantle the very values that are at its heart. We are a party that has always believed in economic and fiscal responsibility; that we should not spend more than our means. This naturally puts a health service with an insatiable appetite for resources on a collision course with Conservative beliefs.
The current pressures faced by the health service are not exclusive to the 21st Century. A growing, ageing population combined with advancements in technology and pharmaceuticals continue to add strain to the system. Advocates of the NHS plead for ever greater resources: they suggest that if it received a higher revenue, pressures would disappear. This is to some extent true: more funding would ease the immediate pressures on the system, but it would only have a short term impact. Previous cash injections have been swallowed up, and none of the underlying issues have been addressed.
However, history shows how these differing outlooks do not need to be in conflict, but can complement each other. After all, the concept of a National Health Service was the brainchild of Conservative thinkers. The 1980s witnessed the NHS experience its biggest reforms to structure and financing in its history. The market reforms implemented under Thatcher’s government created a pseudo-market in which sections of the health system would compete for resources. This, combined with the introduction of a mixed economy for health, would transfer the discipline experienced in a market economy to the health system. The NHS could become more efficient – yet the principles of a health service free at the point of use, based on need and not ability to pay could be preserved.
Central to Thatcher’s health financing reforms was the implementation of a purchaser-provider split: GPs, health authorities and private patients would purchase services from NHS Trusts, directly managed units and private sector providers. Resources became allocated through weighted capitation, so purchaser budgets would be based on the size of the relevant population. This remains in place today. Primary care providers receive the majority of their funding based on the number of patients that they have on their books, therefore funding follows the patient. The introduction of competition and market mechanisms meant that care providers who lost patients would be forced to better their services to compete.
However, many people never change their primary care provider. They often stick to one particular GP throughout their entire life, regardless of the level of service that they receive, and as a result the policy is undermined. The Government has worked hard to publicise the benefits of changing one’s utility company or bank, but never one’s GP. Primary care providers are inspected by the CQC and the NHS website publishes data from the Patient Survey. The information about GP services is out there, but is rarely accessed.
It is widely accepted that a major cause of A&E departments being saturated is because individuals find it hard to obtain appointments with their GP. Often the patients visiting A&E are suffering from symptoms that could be dealt with, at a lower cost, by a GP.
Operating hours, number of appointments per day, number of referrals and waiting times are quantifiable statistics that could assist individuals to ‘shop around’ for health services. Although there are benefits in continuity of care by always remaining at one practice, it is vital that if we want our services to improve, we must to embrace these market reforms. I for one would happily travel to a GP who operates on a 24 hour basis, and where an appointment is easily achievable.
I do not claim that this one reform will solve all of the problems faced in A&E departments, but rather suggest that if the market model was better utilised, with time it could help alleviate some of the current pressures. Thatcher was bold in her health reforms while remaining true to the values of the NHS. It is time for this government to pick up where she left off.