Viewpoint: Scrap the market approach to healthcare, says Dr Kailash Chand

Building on the founding principles of the NHS can help sustain the health service in the face of rising pressure from an ageing population, argues BMA deputy chairman Dr Kailash Chand, writing in a personal capacity for GPonline.

Dr Kailash Chand: opposes market-based NHS
Dr Kailash Chand: opposes market-based NHS

NHS England medical director Sir Bruce Keogh told The Guardian this morning: ‘If the NHS continues to function as it does now, it’s going to really struggle to cope because the model of delivery and service that we have at the moment is not fit for the future.’

Who can disagree with him? I have huge respect and admiration for Sir Bruce. He has consistently challenged politicians to develop policies that ‘unleash rather than constrain’ the intellectual capital of the NHS’s 1.4m staff.

But the question he needs to address is: who is responsible for this mess? The present administration has asked the health service to save £30bn by 2017 - so much for it finding additional money for the NHS.

Market ethos

The NHS reorganisation is facilitating and encouraging privatisation and outsourcing of care, which wastes money on profits instead of using it all to run the NHS. The creation of a market ethos-led NHS and the corporate philosophy of treating health as a commodity and the patient as a target have resulted in a colossal waste of funds with little real benefit to the patient. There is not a scrap of evidence that the price goes down and efficiency increases when private companies deliver NHS care.

In fact, the evidence points the other way. Costs increase and services may well get worse. The fiasco of hospital cleaning has shown the reality of privatisation: apparent short-term savings, but at the expense of lower hygiene standards and undermining the workforce. The NHS is now less cost effective.

Money is being wasted on turning healthcare into a market, in which providers have to compete rather than co-operate and GPs are legally required to spend money on expensive and lengthy tendering processes. Far from being in charge, GPs are effectively rubber-stamping decisions imposed by NHS England and commissioning support services.

Successive governments over the past two decades have encouraged a 24-hour, consumerist environment - a ‘dial-a-pizza’ approach to healthcare.

Sustainable NHS

Alarmist perceptions of ageing as a fundamental threat to the NHS are greatly overblown. It is undeniable that unprecedented ageing of the UK population presents new challenges to health and long-term care, but the solutions are there.

Long-term care, social care, and healthcare should be integrated at different levels of provision, and strengthening primary care is the real key to tackling ageing issues.

As a medical director, Keogh has a great deal to ponder - primary/secondary care capacity, patient demand, political expectations, public perceptions, shrinking budgets, new configurations, quality inspections, integration, technology challenges to name but a few. So can he rise to the challenge? What will healthcare look, feel and sound like in five or 10 years from now?

Is the current model sustainable or will it have to change? In either case, how will it do so? The only way to sustain and reshape the NHS to improve and meet the challenges of the future, including care for an ageing population is to strengthen its founding principles, as a publicly funded and publicly accountable NHS.

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