Public Services ‘Wealth warning’
How public services are financed and provided in the next decade is being debated in a half-hearted way and we are not being radical enough in our thinking. For example almost forty percent of care home residents have to pay their own fees as they have assets in excess of £22,250.00 and yet this element of the care system is facing a £6 billion shortfall within twenty years – and the number of elderly people is increasing, so this is a conservative estimate. Recently the government put forward three options to fill this gap:
• Provide £20,000.00 of free care for everyone
• A voluntary insurance scheme to pay for any excess
• A compulsory insurance scheme to pay for any excess
Other healthcare provision is facing the same issue in a shortfall in funding to enable maximum performance. My view is that we need to take a far more radical approach to what the National Health Service provides. In a recent article Melanie Phillips questioned whether we should provide IVF, gastric bands and other treatments on the NHS. Her full article can be read at www.melaniephillips.com. (As an aside, other articles from Melanie are well worth reading, as she puts key issues in a sensible and easy to understand way.)
Politicians are saying that they want to be honest about future public service provision, whereas the reality is that they are putting forward their ‘least bad’ option to try and attract voters. I can’t imagine Gordon Brown standing at any podium and saying that he has made the country bankrupt and David Cameron and Nick Clegg can only talk about making things better in the future, without addressing the fundamental fact that we have become a consumerist society.
When any treatment is made available then we all want it, irrespective of the cost. I am, unfortunately, old enough to remember when Dr. Christiaan Barnard conducted the first heart transplant. It was reported that this expensive operation would be a rarity but now, if someone is unfortunate enough to need this operation, then it is almost viewed as a right. This has become the same situation with a number of treatments, whether operations or courses of medicines, which has led to senior NHS leaders having to make difficult financial and ethical decisions about which treatments they will – and will not – provide and to who. Some of these decisions have then been challenged in the courts, leading to the accusation that the treatment you receive is a ‘postcode lottery’.
When you look at this in a personal perspective, it’s like saying that we all have the right to whatever we need at home. We can all go on whatever holiday we choose to go on, drive whatever car we choose and live in whatever house we want, because they’re available. Put like that it sounds like absolute nonsense and yet that’s what we expect from the NHS. If politicians were honest about public service provision they would be making some difficult decisions themselves and being clear about what there is enough money to provide. Nick Clegg, leader of the Liberal Democrats, recently said that we must not leave the next generation in the position we’re in now. That’s only going to be achieved by making it clear what the NHS will provide – and what it won’t provide – in the future. Unless this country continues to borrow money that it cannot afford to repay then the ‘customer expectation’ needs to be managed and the purpose of the NHS refocused on what it was originally set up to do. If that means that people need to take out private medical insurance then tell them now. That way the next generation will have a NHS they can afford and that will provide them with a clearly expressed level of care. It will also allow senior managers a realistic chance of having performance and strategy plans to deliver this to a high standard instead of being continually asked to meet unrealistic increasing demand with insufficient resources.