NHS needs fundamental reform not more money

Here we are again with another election looming and the NHS in the centre of the fray. Only this time, the debate isn’t about whether the NHS needs more cash. Spending has increased by 40 per cent in real terms in just five years and all the major political parties are pledged to spend much more.
The question now is different. Has this money transformed the NHS, as Mr Blair boldly promised it would after the 1997 election? While there might have been improvements, they are at the margins and we are still nowhere near to having the kind of healthcare our European peers enjoy.
Waiting lists have been reduced since the explosion in spending but the average waiting time has remained stagnant and under some measures increased.
Have treatment outcomes improved? This is notoriously difficult to assess, but the international evidence shows we still perform poorly. Survival rates after cancer are amongst the worst in Europe with only the Eastern European countries performing worse. In a recent study examining mortality amenable to healthcare the UK was ranked 18 out of 19 European countries.
Many argue that the beauty of the NHS is that it provides access to care to everyone no matter their status or wealth. This is nonsense. The quality of service all too often depends on being articulate, having an intimate knowledge of the NHS or where you happen to live. This inequity discriminates against the elderly, the less well educated and the less well off.
Before suggesting that the answer is to continue pumping more money into the system, we should consider the Scottish example. NHS Scotland spends £200 more per head than England, but greater resources have not improved outcomes; waiting lists and waiting times have both increased. No-one would seriously hold up the Scottish NHS as a model for healthcare delivery.
What the NHS needs is structural reform. The only way to guarantee equity, universal access and remove politicians from controlling the minutiae of care is to give power directly to the patients. We should fund patients, either through the tax system or by way of universal insurance, to purchase healthcare from the provider of their choice. The poor and unemployed would have their contributions supplemented or paid for by the state.
Patient power would allow resources to be directed to those units providing quality and capacity. Competition would drive up standards. I believe that health professionals have as much to gain as patients from reforms which restore the doctor-patient relationship and eliminate the bureaucracy which is bedevilling our working lives. At last clinical priorities rather than political targets will govern the way we work.

This is the approach favoured by Doctors for Reform, the non-party independent group of nearly 1,000 NHS doctors of which I am a member. We do not advocate a single model of healthcare as each has its drawbacks, but it is clear that Continental systems of social insurance provide minimal waiting lists and quality outcomes. Politicians take the role of guarantor of care and occasional regulator. We should debate these alternatives maturely. It will need a lead from those of us in the NHS to show that real change is in the interests of professionals and patients alike.

Christoph Lees
Founding Member, Doctors for Reform
And NHS Consultant

http://www.doctorsforreform.com/page.asp?pid=80