Saving the NHS through innovative funding and structural changes

Additional funding and structural changes to NHS service provision are required to save the NHS.

In summary:

The phased introduction of a Health Insurance Supplement, in later life, in conjunction with the implementation of simpler more cost-effective NHS care pathways would address some of the inequalities in society and help fund the shortfall in NHS provision.

What are the issues?

Older people use disproportionately more of the NHS resources than the general population, especially in their last year of life. The over 65s may represent just 20% of the population but they consume about 40% of the NHS budget. This imbalance can be rectified by my proposal.

The Covid-19 pandemic has exposed inequalities between those relying on earned and unearned income. Those living on unearned income have generally been spared financial hardship during the pandemic, with many able to make additional cash savings. Although unearned income has declined due to both the pandemic and Brexit, those affected are generally retired and without the financial burden of raising a family.

However, where the retired population is suffering is being unable to readily access medical diagnostics and treatment under the NHS and hence fulfil their lives. Although statistics are produced on patient numbers waiting for treatment and surgery, these data fail to reflect the true situation. Patients can find they are not even registered on the lists from where the statistics are drawn.

How can these issues be addressed?

An effective solution would be to introduce a Health Insurance Supplement (HIS) at 50 years of age, when one’s children are reaching an age when they can earn and hence require less parental financial support.

How would this work?

It could:

– Operate like employee National Insurance (NI) contributions and be linked to income – i.e. payable above an earnings threshold and then reduced for example to 1% of income above a higher limit (i.e. akin to the upper £50,000 p.a. threshold for NI in 2020/21).

– Start at for example 1% of income at age 50, increasing to 2% from 55, 3% from 60, 3.5% from 65 rising to 4% of income from age 70.

– Unlike NI contributions that stop at retirement, HIS would continue for life and based, like NI, on the ability to pay. This would reflect the reality that older people consume more of the NHS.

To determine the optimum contribution levels, modelling is required to quantify the money generated and its impact on enabling improved NHS service provision.

It is hoped that this new Health Insurance Supplement would come from disposable income, so the impact elsewhere in the economy needs to be assessed. Likely effects include a reduction in spending by older people on travel, holidays, helping younger members of the family and on resorting to paying for private healthcare.

The income from the proposed HIS will still fall well short of the additional funding required by the NHS to deliver sufficient essential health services for the ageing population. The additional funding therefore needs to be combined with the much-needed improvements, in the efficiency and effectiveness of NHS provision, through fundamental structural changes to the NHS.

Currently, older people are faced with funding certain basic healthcare themselves. GPs are often faced with the embarrassment of telling patients that if they want to secure a positive health outcome before it is too late, the only solution is to pay privately. This is to avoid irreversible damage to their body, retain mobility and enable an active life. After lengthy waits, for example to treat troublesome hernias, arthritic joints, painful limbs, vascular problems causing excruciating ulcers and to diagnose cancers, many older people are driven to fund procedures themselves. Costs for private diagnoses in NHS facilities can be exorbitant and far in excess of the actual cost.

In tandem with the new proposed HIS contributions, essential healthcare services need to become more readily available. Care pathways in the NHS must be simplified and shortened, with many of the intermediaries (often private companies), which are hindering rapid service delivery and recycling problems, being removed. These circuitous routes to care currently add financial cost, create excessive delays in healthcare and cause unnecessary morbidity and mortality.

Clear referral criteria need to be approved such that GPs and other referrers can use their judgement and refer straight to the treatment provider. A simple audit process can be implemented to check that the agreed criteria are being met.

If older people are investing their disposable income in the HIS, then the NHS services they urgently require and expect in their later years need to be assured. It is far more cost effective to pay more into the NHS for good NHS provision. Resorting to depleting personal savings to self-fund urgent and essential elements of private health care i.e. that the NHS has been unable to provide is an inefficient use of scarce funds. However, if this money is now invested in NHS provision then there needs to be a mechanism by which standard healthcare is guaranteed.




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