Benenden’s Medical Director speaks out about the future of healthcare
6th October 2015
At this week’s Conservative Party Conference, Benenden’s Medical Director John Giles spoke out about the problems facing the NHS and the role mutual healthcare can play.
At a panel discussion Benenden hosted in partnership with the thinktank Respublica at the Conservative conference entitled ‘A Better Health Service: Placing people and communities at the heart of care’, John Giles was joined by guests including Andrea Jenkyns MP and Alex Fox, CEO of Shared Lives Plus.
Speaking at the event John Giles, Medical Director of Benenden said, “I think everybody agrees that there are enormous problems facing the NHS. For as long as I can remember throughout my professional career, and that includes 12 months as a hospital porter and 5 years as a medical student it has ever been so. But I believe the scale of the problems facing society and how we provide healthcare are greater now than ever before and somehow we need to try and find imaginative solutions.
“From its inception over 60 years ago the NHS has grown year on year and lurched from crisis to crisis. Each problem as it arises demands a different solution and inevitably there will be unintended consequences arising out of these solutions. Don’t misunderstand me – I am a great supporter of the NHS and there is no doubt it probably represents the most cost effective means of pooling risk and providing the majority of necessary services. But equally a one size fits all approach can only lead to some dissatisfaction for a large number of individuals for one reason or another. Because everybody is different, each individuals needs are likely to be different.
“Population growth and changing demographics, aging and the associated increased in the prevalence of chronic diseases will continue to place enormous burdens on NHS services. Average life expectancy has increased from 76 to 81 between 1990 and 2013. That’s another 5 years of life requiring an average spend of up to £10K per person per year compared to the average annual spend of approximately £1000 per person up to the age of 60.
“Medical advances have led not only to improved survival and better quality of life but these factors have also led to increased expectations. A large amount of what we do in medicine now was not even dreamt about when the NHS was originally conceived. Things we nowadays take for granted such as coronary bypass surgery, joint replacement surgery, most cancer treatments and my own specialty of medical imaging were a long way over the horizon and not envisaged when the NHS was established. We also have to wonder why 50% of the population takes regular prescription drugs. The obese are more likely to need prescription drugs - many of which are a substitute for healthier lifestyles.
“A recent survey undertaken by Benenden clearly demonstrated that we, as a society and the end user of these services, not only have a poor understanding of cost but expect the NHS to always be there to pick up the pieces - whether the illness and misfortune which we will all eventually suffer is unavoidable or whether the result of our own poor lifestyle choices. The same survey also indicated that the public thought that patients suffering from lifestyle related conditions should be expected to make a greater contribution to the costs.
“Recent research has shown that 40% of NHS resources are spent dealing with preventable risk factors such as smoking, alcohol and more importantly diet. The study by Public health England found that nearly 11% of ill health and early death was related to tobacco smoke, 9.5% due to obesity, nearly 8% high blood pressure and 5% due to alcohol and drugs. This obviously has to be viewed alongside the £20M contribution – nearly 20% of total, to NHS costs from alcohol and tobacco taxes - around £10B each per year.
“We also know that there are huge regional differences in life expectancy correlating with deprivation. Men in the wealthiest parts of the UK can expect to live 8 years longer than those in the poorest parts. This gap has not changed since 1990. Perhaps it is not unreasonable to expect that those who can afford to pay more should do so? Somehow we are going to have to try and find the resources to fill the anticipated £30 billion black hole in NHS finances which has been predicted in the Five year forward view. The additional £8 b will help but clearly we need to find the rest from somewhere - probably not the magic money tree!
“What is really needed is for decisions to be made closer to and involving the individual. Whilst some less fortunate members of society will always need help to make complex decisions, I believe most people are happy to take more decisions for themselves when presented with a number of options. This is also a means by which the public can be more accountable for and aware of the consequences of their own decisions.
“The idea of personal health budgets is not new and for some services increasingly accepted but this is not really workable across the spectrum of health care. Somehow we need to involve the individual or groups of individuals to take a greater responsibility for themselves.
“The mutual model, where organisations which are owned by members, and providing services for the benefit of members and not shareholders, private equity groups or for profit, can be a natural partner for the NHS. They enable decisions to be taken closer to the individual and more tailored to the needs of an individual rather than what can sometimes seem to be more for the benefit of the provider. By providing a cost effective means to deliver a range of services, some of which may be unavailable on the NHS, selected by the members, for the members, can complement and supplement core NHS care. The NHS’s limited resources can therefore be more focused on those who are in greater need. It could also provide a means to provide an additional source of funding for the overall health economy.
“There is no easy or right answer to our current problems with healthcare provision. Yes, in the short term we can simply direct more money to the healthcare budget -another £8 billion was pledged before the election. But that money has to come from somewhere, we know the public is reluctant to pay more tax. Especially for something they increasingly take for granted and at the same time seeming to undervalue.
“Those of us who work in the NHS can try and make some efficiency savings but we have been trying to do this for as long as I can remember. There is a limit to how much real efficiency savings we can actually make and such efficiencies are often more of a repackaging and relabelling of services. Controls on public sector pay can only go so far and somehow we are going to have to make difficult choices about what can be done and how we pay for it.
“I think involving mutuals to help facilitate individual choice, decision making and accountability as well as provide an addition source of revenue is more palatable to the public than the alternative private insurance based model. Mutuals are not a threat to the NHS and are generally praised by members. Trying the save the NHS in its current form is not going to solve the enormous problems facing us. I really think that in the current political climate we have a once in a generation opportunity to discuss as a society how we want our healthcare to be delivered and perhaps more importantly how to pay for it.
For more information on how Benenden advocates the future of mutuals in healthcare, take a look at the Respublica Report, sponsored by Benenden.