Hundreds of NHS doctors have swarmed upon Westminster to demonstrate the seriousness of problems that could see them fleeing the NHS for jobs in Australia and New Zealand.
Apparently oblivious to the damage such a statement causes to the dependable reputation of the NHS they proclaimed that they represented “most doctors” and they described the immediate future of the NHS as “not safe”.
Regular readers will know that this blog recommends a model based on monthly subscription service, with prices negotiated in the same way that accountants and gymnasiums negotiate, supplemented by insurance with a well defined scope of coverage.
Doctors chose their career knowing that the system was managed by a remote political elite who may make decisions they disagree with. That management model is unique to the NHS and it is not the only way of managing an affordable health system. It is not even the only such system this country has had.
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Medical care is not needed when someone is young and in good health – it is needed when someone is old or sick. That is why long term contracts or associations are a good idea – “fraternities” (what British people used to call “Friendly Societies”) are a (a – not the) logical answer. Voluntary associations of people (over generations) bound together by rituals and practical aid – employing doctors (and other needed craftsmen) per month (not per treatment) to help members and their families.
Of course some of the leading hospitals of Britain (such as Barts) were “free at the point of use” for centuries – due to voluntary donations.
The idea that everything is either commercial or state (that the poor have no place in a free society) is false.
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There is a difference between sectors.
Catastrophic events like cancer, major accidents, is something that tends to suit an insurance or friendlies model.
Routine GP services and more elective events are not the same, and, imho, can benefit from a more direct link between payer and consumer.
The elephant in the room is how to turn around the NHS supertanker without everybody sliding off deck and into the sea. I did propose one approach on these pages many moons ago. It would bring us nearer to a Swiss model. Once there, things can evolve further.
P. S. A big problem we have now is medicine can stop us dying, but is not as able to keep us living.
Hopefully, advances on dementia, powered exoskeletons and robotic help will redress that balance.
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‘Doctors chose their career knowing that the system was managed by a remote political elite who may make decisions they disagree with.’
I think living the reality of this once qualified is more enlightening than perhaps hearing about it as a teenager!
Of course nothing is completely polarised. Working as a doctor IS great at times. It can be personally and intellectually satisfying, with a reasonable income if living outside of London, although less compared to one’s academic peers who joined other state sponsored industries, such as banking.
Many good doctors would be good doctors under a system that wasn’t the NHS, and these are the doctors you would still see.
The reality is that doctors don’t actually strike often or properly. Like many professionals those most aware of the risks in the current system burn out (retire early), locum or leave the NHS and / or country. Ayn Rand had a good insight into how skilled people protest by simply disappearing!
Recent Jeremy Hunt whinges about the cost of locums fails to understand that in a managed economy the locum cost is one of the true price signals left.
With regards to influencing doctors, do not see them as an enemy for realising the limitations of the system but not understanding the answer. The argument that does need to be pushed, however, is that is it illogical to ask for full government funding via taxes (the NHS) yet bemoan subsequent government influence. Universal healthcare coverage occurs elsewhere outside of the NHS.
Kristian Niemietz, who I see was at the Cost of Living talks, speaks well on this topic: http://www.iea.org.uk/blog/the-future-of-healthcare .
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With regards to private primary care in the UK there is a trade-off in the patients one would see, given the current system crowds out complex primary care to those who would use NHS investigations, referrals and prescriptions. There is a living to be made seeing the worried well or the acutely ill privately but my own preference would be to continue to see patients I see on the NHS, but with the opportunity to offer top up payments for extra convenience or to continue to access the excellent service my practice provides!
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Simon I’m going to bite at the implication in the piece! I think there is a tendency in political circles to conflate the morality of the actions of the individuals with the morality of the system that incentivises them to take such action.
Given we all are individuals, with our own morality and incentives, I think it is more useful to look at the system rather that by judging the individuals.
Thus a doctor working in a system with effectively one employer may become incentivised to take collective action, either to protect / improve their own working pay and conditions and/or to ensure the service can retain enough staff to be safe and effective. Both these outcomes help the individual who is protesting.
In the same way malinvestment of people’s working lives – and I’m happy to use banking as it draws in so many talented people yet is heavily subsidised – is not a moral statement on those choosing to do those jobs. Rather it is an indictment of the system (government control of money and regulation) that incentivises those individuals.
It is extremely important to highlight how it is the systems that skew the incentives to individuals, as this is the only way to improve matters without retreating into tribal, political, class, professional or religious based conflict.
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