How to fix a ‘third world’ NHS service

On the eve of its 70th birthday, the NHS is creaking under the most intense strain it has faced in decades - crippled by underfunding, staff shortages and a cold-weather influx of patients with flu and breathing problems.

An A&E doctor yesterday went so far as to apologise for the “third world conditions” in his overcrowded unit, while news emerged today that up to 55,000 non-urgent NHS operations may be postponed to offset the winter crisis.

“There’s no doubt that this is becoming an annual event now - the annual NHS winter crisis, whereby the NHS which is running at full capacity at all times simply cannot cope when it comes to winter,” says Sky News reporter Beth Rigby.

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Conservative MP Sarah Wollaston, a former GP who chairs the Commons Health Committee, told BBC Radio 4’s Today programme that Theresa May and her cabinet need to “get a better grip” on the problem.

Health Secretary Jeremy Hunt sidestepped questions today about whether he was ashamed by NHS levels of service, instead apologising to the thousands of patients likely to be affected by cancelled operations.

NHS funding options

There’s no easy solution, but a rethink of NHS funding certainly appears to be in order.

Many commentators have suggested a switch in the way the NHS is structured: from a single-payer system to either a 100% privately funded social insurance system or, like many other OECD countries, a combination of the two.

The UK’s single-payer system - where expenses, such as paying doctors and buying drugs, are controlled by the Government - is cost-effective, allowing the UK to spend less than 10% of GDP on health spending.

Other countries have experiemented with other models, however. Sweden’s health service is largely taxpayer funded, for example, but patients pay a fee to see a medical consultant on a pay-as-you-go basis, capped at SEK 1,100 (£100) a year.

In the Netherlands and Switzerland, health insurance is handled almost entirely by private insurance companies, while doctors and hospitals are generally private.

“Coverage is universal because citizens are legally obliged to buy it, which ensures that healthy people stay in the system, holding insurers’ costs down,” says The Economist. “The government keeps premiums affordable by pumping in generous subsidies, and bars insurers from rejecting those with pre-existing conditions.”

Time for a budget overhaul?

If the cost of changing the system outweighs the benefits then the UK needs to spend more on the NHS, as the service’s finances are “in a much worse position than they have ever been”, Chris Ham, of The King’s Fund think tank, told The Economist.

“It is all about the money,” adds Jennifer Dixon of research charity The Health Foundation.

Factoring in inflation, the NHS is suffering the longest budget squeeze in its history.

Since 1948, spending on the NHS has grown by 3.7% per year, on average. From 2010-11 to 2020-21, average growth is expected to be 0.9%. Healthcare spending as a share of GDP in 2014-15 was 7.3% and is projected to fall to 6.6% by 2021, according to The Economist.

But where is the additional money for the NHS going to come from? Inevitably, taxes. That may not prove to be such a problem in the long run, however. A King’s Fund survey in September found that two-thirds of the public are willing “to pay more taxes in order to maintain the level of spending needed” on the health service.

With NHS hospitals forced to take drastic measures to deal with the winter crisis, many critics say it is time the Government did the same.