Saturday, 22 April 2017

What does this snap election mean for health in the UK?

Like the majority of the country, I was gobsmacked by the announcement that an election was to take place in June. My immediate reaction was to think ‘well this lady is for turning’ as Theresa May went back on her original statement that an early election was not planned. First the U turn on National Insurance for the self-employed – and now this. Comparisons with the ‘non turn-able’ Mrs Thatcher are inevitable and one can’t help wondering if this could be a trend for the current premiership.

But Politics aside - my main concern is what this snap election means for the National Health Service and healthcare in general. When forming her new cabinet last year, the Prime Minister indicated that the NHS seems a low priority. She had the ideal opportunity to remove a bloodied  but not bowed Jeremy Hunt from the front line and replace him with a minister with a more conciliatory approach. Ask any clinician, support worker, or even administrator in the NHS and they will all tell you that the NHS is already ’24 hours’ for emergency and critical care but to extend this to non-urgent treatment would be spread already thin resources to a non-sustainable conclusion. The toxic relationship between the Secretary of State for Health and the junior doctors has reached a point where divorce is the best option and a new relationship needs to build. Ignoring something that is broken means that it will become beyond repair.

I have some sympathy for government fiscal policy and agree that a strong economy is vital for a ‘healthy’ NHS but the chronic underfunding of the state provision cannot be ignored.

I was working on service improvement projects in the NHS at the time that the 2012 Health and Social Care Act was being implemented and experienced at first hand the genuine distress caused by Andrew Lansley’s ill-conceived reforms. At that time it was predicted that General Practitioners would leave the service in their droves and this is proving to be the case. Just this week a survey of 15,000 doctors demonstrated that at least a third of GPs were planning on retiring within the next five years while 19% of trainee GPs were considering work abroad. This is particularly worrying in the context of Philip Hammond’s autumn statement – funding more GPs to take the pressure off Accident and Emergency departments. Where will these GPs come from? Joined up thinking is required but clearly seems to be absent.

Talking of joined up thinking – the increase in Insurance Premium Tax (IPT) from 10% to 12% announced last year and planned for June will have an indirect but potentially devastating effect on the NHS. We will all have to pay extra for our motor, home and other essential insurances, and one could argue that the treasury’s finances have to be boosted from somewhere – but this tax also applies to private medical insurance. Before people start leaping in with criticism for private healthcare and ‘why not tax the rich’ – they should be aware of some crucial information (supplied by Laing & Buisson UK Market report thirteenth edition):

·    6.9 million individuals are currently covered by private medical insurance (PMI) policies
·     10.6% of the population has access to private medical care through PMI
·   These policies cost a total of £4.7m in 2015
·  £3.6m claims were paid for private treatment in 2015
75% of these people insured are members of company paid schemes as an employment benefit. These employees are liable to tax on the benefit so for an average single rate of over £1,000 annually an additional £120 will be added for IPT and the employee pays tax on £1,120 – the total cost of their cover.

Thanks to improved survival rates, improved diagnostic technology and life extending treatments, medical inflation runs at 10% year on year. This is, of course, the reason that the NHS needs constant uplift in funding. Add another 2% this year to the cost of private medical insurance and some subscribers (both company paid and private clients) will find the costs of private cover unaffordable and may well opt out of their private schemes.

So where will these people seek treatment in the future? The NHS. This is almost a ‘duh’ moment. Come on Mr Hammond, think about it – how would the NHS cope with a flood of extra patients who previously accessed private care.  Could this be a tipping point for the state funded system?

Back to the snap election. As we all know – during the pre-election build up, the business of government goes into a state of suspended animation and parliament will be dissolved on 3rd May. This is particularly disappointing for the Association of Medical insurance Intermediaries (AMII). We had launched a petition to appeal for a change in government policy regarding IPT for private medical insurance. I strongly believe that a robust private medical system in the UK can complement and supplement the NHS rather than compete with it. Increased taxation can only hinder this symbiotic relationship.We shall regroup as soon as parliament sits again and the delay is irritating rather than catastrophic but we are committed to pursuing our aim of maintaining the affordability of private medical care.

Jeremy Corbyn's plans for the NHS also ignore the value of cooperation between the public and private sectors with his bold claim of stopping all NHS work in private facilities. He fails to mention how this will be achieved, ignoring the shortages of NHS staff, building collateral and need for investment in new facilities. Chuck in an extra day's bank holiday and his plans become even less realistic.

I will refrain from commenting on the potential outcome of the upcoming election.  But I hope that whichever party or coalition is in power after June 8th,  they will use the opportunity to a) change the Minister of State for Health who will b) adopt a cooperative rather than confrontational approach to the clinical staff threatening strike action and c) listen to NHS leaders before acting further and d) engage with private medical providers to ease the pressure on the NHS.

It’s not too much to ask for – is it?







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