The letter Theresa May received sparked once more the debate on the NHS funding. In fact, the current situation in hospitals across England is close to a disaster. The queue in emergency units keeps growing, people have to wait for hours before being taken care of. The Prime Minister underscored that this crisis was mainly due to the flu. Yet, the situation appears to result from other factors: although the flu may have slightly increased the number of patients in hospitals, the main issue remains the lack of investment. Nurses and doctors are not numerous enough to take care of all patients and it is essential the NHS takes a new shape. To reach this objective, investments are needed but the government doesn’t seem to be willing to pay out more money.
The NHS model is not working well and finding an alternative to its funding is not a piece of cake. Should council taxes increase or should the government choose another solution?
Structure de l’article:
- Theresa May received earlier this month a grim and even alarming letter from 68 doctors working in or running A&E units in England. This letter decries the lack of money the NHS is suffering from. Indeed, this underfunding has led to an appalling situation where patients are bound to receive poor care since there are not enough beds or staff. Crowded emergency departments are dangerous for patients who are then likely to die prematurely as it is the case now.
- Given the situation, some hospitals feeling powerless in front of this crisis, have ended up breaching their constitutional obligations. Despite the implemented plan and the Prime Minister statement which stressed that flu was a key factor in the intense strain that the NHS services were facing, this crisis appear to be the outcome of seven years of austerity.
- This letter has reopened the debate on the NHS funding inasmuch as an alternative funding model seems vital: the idea of a NHS tax has emerged with the Conservative MP Nick Boles. A program has recently been launched to conceive a 15-year plan that would rethink the NHS.
- Most people agree on the NHS blatant needs: the issue is real since the healthcare occupies quite the same part of the GDP than in other similar countries, however the result strongly differs.
- The NHS has to come to grips with a thorny issue, namely its role. Hindered by too many rules in its constitution, the NHS needs to scale up since it could offer better care for the same money but this evolution will have a cost. Who will pay for it?
The taxpayer-funded service which provided health care at the point of use is so precious to the public’s imagination. Still, hospitals are struggling to make ends meet and face a funding gap of £20 billion. Those difficulties are increased by the rising demand for health care from an aging population. Therefore, managing demand now involves more emphasis on preventive medicine (prevention is less costly than cure) and that is why the government is trying to do with the flu.
- stark: frappant (différence)/morne (couleur)/sombre (réalité)
- A&E: service des urgencies
- to breach sthg: enfreindre qqch (loi)/manquer à qqch (promesse)/ouvrir une brèche dans qqch (defense)
- to avert sthg: éviter qqch
- a think tank: un groupe de réflexion
- across the board: à tous les niveaux
- a ward: une salle (hôpital)
There is no mistaking the depth of the crisis faced by the health service. But how much are we prepared to pay, who will pay it – and what exactly will it buy?
It has been a terrible day for the NHS in England and Wales (and not a lot better in Scotland, where there are also complaints about long waits, or Northern Ireland). But it was even worse for the health service’s political masters. An unprecedented letter was sent to the prime minister by 68 of the most senior emergency medicine specialists from across England and Wales. It warned in the starkest terms of the extent of the crisis in A&E caused by “severe and chronic” underfunding: some care was not safe. Treatment was taking 10-12 hours from the decision to admit to finding a bed. For want of that bed, people were dying on trolleys. Patients were sleeping in clinics. Sometimes 50 patients at a time were waiting in emergency departments. They need more staff, more beds and more cash for social care.
Earlier, the body representing all NHS providers warned that the funding crisis had driven hospitals to a watershed where hard choices were becoming unavoidable. As they have for more than a year, most hospitals are breaching their constitutional obligations. The warning accompanied statistics showing that only 77.3% of A&E patients met the four hours target in December. Performance is already worse than in its worst month, January 2017. It the worst since records began, and it is very likely to get worse still. Theresa May suggested to reporters that it was because of the flu epidemic. This is not the flu: it is a system-wide crisis brought about by seven years of mounting austerity. Oh, and that is getting worse, too. The official defense is that this is not a crisis, because there is a plan. Certainly the consultants acknowledge in their letter to Downing Street that huge effort went into trying to avert a crisis. But planning can’t magic up highly trained doctors and nurses. Plans do not make hospital beds. And while vaccination helps, you can’t entirely plan your way out of the impact of flu.
Amid the mounting alarm, some influential voices are calling not just for an urgent dose of cash but for a different funding model altogether, one that would avoid the financial rollercoaster in which the NHS and the patients who rely on it are trapped. There are proposals – the latest came from the Conservative MP Nick Boles, who has cancer – for a hypothecated NHS tax. The Health Foundation think tank has just launched a programme with the Institute for Fiscal Studies to try to reach an independent assessment of what a sustainable 15-year plan for the health service would look like. The Tory chair of the Commons health committee is among 90 MPs calling for a non-partisan conversation on the shape of a sustainable settlement. In a Commons debate on Wednesday, even the health secretary, Jeremy Hunt, accepted the need for more money and a 10-year settlement.
The thought behind these increasingly urgent demands is that there is some way of reaching agreement on what the NHS needs. That is not as easy as it looks. The percentage of GDP spent on healthcare is a useful comparator with other similar countries but it doesn’t describe what an individual health service looks like.
The US spends most in the world, more than 17% of its national income, on health while denying access to it to 44m uninsured Americans. The Commonwealth Fund, where across the board the NHS repeatedly performs better than any of the other 11 richest countries, uses technical measures like access and efficiency. It may be more useful to ask – as the limited obligations set out in the NHS constitution try to do – what the NHS should provide. Knee replacements for 90-year-olds? IVF for 50-year-olds? Mixed-sex wards for our elderly mother? A local A&E or a more distant centre of excellence? On Wednesday, Chris Williamson, a junior Labour spokesman, “resigned” after suggesting doubling the top two bands of council tax, to meet the bill for social care. But he is right to highlight the political debate we need to have. How much will we pay and who will pay it?