What’s so good about the NHS?

Put to one side for a minute the almost constant stream of negative NHS stories, of cuts and deficits and waiting lists, and consider just how successful the NHS has been and still can be given the right funding.

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The NHS is one of the few totally publicly-funded healthcare services in the world and since 1948 has treated and saved the lives of millions and millions of people. Each one of those patients was treated on a basis of their need rather than their ability to pay. Each one of those patients was able to access advanced medical technologies and up-to-date medicines as a result of the NHS.

All healthcare systems face challenges

The world has changed a lot in the sixty or so years since the birth of the NHS and the NHS is facing many challenges as the population ages and the cost of innovative medicine and medical technologies increases. However, these challenges are not unique to the NHS, all developing nations are facing major pressures on healthcare due to an ageing population and the increasing cost of innovative medicine and medical technologies.

Despite the unprecedented squeeze in funding, the NHS has remained one of the best and most efficient healthcare systems in the world. The reason the NHS has this position is rooted in the fact that it is a totally publicly-funded organisation that is countrywide.

Through a vast network of organisations, the NHS gives value for money, allows fair and equitable access to care, and is adaptable to a changing world. The NHS has exactly what is needed to provide world-class healthcare for the future, if only it were funded well enough.

Top for value for money

If you are looking for value for money from a healthcare system, the NHS certainly offers that. The 2014 Commonwealth Fund report compared the healthcare systems of 11 wealthy countries; the NHS ranked first overall on quality, access and efficiency and was first on many individual measures, this is despite spending on healthcare in the UK being the second-lowest amount per head (healthcare spending is private plus public spending).

The NHS was better value for money than the healthcare systems of the US, France, Germany, Sweden, Canada, The Netherlands, Australia, Switzerland and Norway. Of the 11 countries in the analysis, only New Zealand spent less per head on healthcare, but it ranked 7th on the overall rankings for healthcare, a long way behind the NHS.

There are always commentators that insist that a social insurance based-system is more efficient  – these results from the Commonwealth Fund report show that this is not the case.

The UK is not alone in facing rapidly rising healthcare costs. However, in developed countries where healthcare is funded via a system of compulsory social insurance, then insurance contributions have to increase to maintain healthcare standards. These contributions are by individuals and employers and in many respects social insurance works as just another form of tax on the individual and employers.  Moving to a social insurance model would be replacing one form of tax with another form of tax.

Fairness

At the heart of the NHS is the idea that access to healthcare should be equal for all and not dependent on anyone’s financial status. In the Commonwealth Fund report the UK came top in access to care, which included measures of patients going without healthcare due to payment issues or difficulties accessing the correct type of medical care. Without a doubt, the NHS is one of the fairest healthcare systems in the world as by sharing the costs via taxation, high quality healthcare can be administered to everyone according to their need.

The NHS is adaptable

Since 1948 the NHS has shown that it can adapt to changes in the medical field.

New medicines and medical technologies are very expensive. In other healthcare systems access to these would be dependent on your insurance cover, which would in turn be dependent on how much you and your employer are willing to pay, or dependent on how much you can afford to pay in medical fees. In contrast, under the NHS it is possible for everyone to have access to the latest technologies regardless of financial status.

The NHS has always managed to incorporate new technologies into its service, making them available to the whole population: organ transplants began in 1960; computer tomography in 1972; and keyhole surgery and magnetic resonance imaging in 1980. And since 1948 the NHS has prescribed innovative medicines soon after their launch for hundreds of medical conditions, including heart disease, cancer and diabetes.

The NHS is a network

The NHS is a network and can work cooperatively enabling the organisation to share good ideas, staff, expertise and new technology. It is possible for patients to move to other areas of the country if this is needed for their care.

The position of the NHS in the country and its ability to act as one organisation with shared goals and strategy allows it to be a cornerstone for developing public health policies and introducing healthcare strategies. This is beneficial for the health of the entire population. Initiatives such as the anti-HIV public information campaign in the 1980s were made far easier by the position of the NHS as a countrywide network. Other public health initiatives include the Stroke – Act F.A.S.T campaign and the introduction of screening for cervical, breast and bowel cancer.

The organisation of the NHS means that there is a great potential for exerting control over prescribing, which has been invaluable at keeping down the total cost of medicines.  A key policy for the NHS has been the switch away from proprietary drugs still under patent to cheaper (but chemically identical) generic medicines produced once patents end. According to the King’s Fund this policy across the NHS has saved it around £7.1 billion from 1976 to 2015 and allowed 490 million more items to be prescribed without an increase in total spending. The UK now has one of the highest rates of generic prescribing worldwide at 84%.

Patients are put first

Perhaps one of the most important aspects of a publicly-funded organisation, is that the NHS does not need to make a profit, all funding can go to making the NHS work for the patient.  The NHS is not beholden to shareholders who demand a good return for their investment.

The NHS means that there is no insurance company bureaucracy to deal with before or after a patient is treated, no possible refusal of an insurance claim, no dictating exactly which hospital can treat you, no lists of allowed treatments under your insurance cover, and no massive co-payments to deal with.

In the Commonwealth Fund report the NHS came top for access, for both timeliness of treatment and as a country where patients where least likely to have cost-related access issues.

A dedicated workforce

The NHS has always been committed to a high level of training and its staff are dedicated to applying high standards of care.

The NHS is the best

So there we have it – the NHS – a publicly-funded healthcare system that’s not only free at the point of need, open to all regardless of financial position, adaptable to a changing world, and focused on the health of the entire country, but also great value for money.  The NHS is facing enormous challenges, but it has proven time and time again to be the best system for the entire population.