Doctors’ Policy Research Group is sparking debate on funding reform and the need for integration
Elliot Bidgood, 17 September 2013
On two fronts, the Doctors’ Policy Research Group (DPRG) is currently seeking to spark debate about the future of the NHS; the need for a rethink of NHS funding and the need for a sensible approach to health and social care integration.
Yesterday evening, Dr Christoph Lees of the DPRG appeared on Radio 4’s Costing the NHS, which focused on the NHS England report “The NHS belongs to the people: a call to action” and its warning about the £30 bn funding gap the NHS may face by 2020/21. Dr Lees appeared alongside a wide range of other prominent voices from the healthcare policy community, and put forward his case for how the NHS could face up to its growing funding challenges without sacrificing quality of care. With the challenges facing the NHS as great as they are, forums for reasoned public discussion such as this are vital, and the BBC should be commended for organising the programme.
Dr Lees’ contribution to the discussions (starting about 1 hour and 6 minutes into the programme) was to argue that the NHS is limited by its sole reliance on general taxation, meaning that a more mixed funding system of contributory social insurance and co-payment would be preferable. Dr Lees pointed out that the NHS is not ring-fenced, as in contrast to much of Europe our healthcare spending is actually decreasing at the current time. He argued that this is because voluntary private spending in European health systems in the form of co-payment, co-insurance and top-up payments allow for extra funding to be introduced to the health system, in contrast to the tax-financed, and thus “cash-limited”, NHS. He also noted that a system like this was originally envisaged for the UK in the Beveridge Report of 1942. Listen here for the full programme.
After the show, Dr Lees said:
“In a debate about funding, no-one mentioned any funding alternatives to a tax based system and the idea of social insurance-the basis of many European models, was not considered as practical or desirable.
“Nevertheless this form of funding is prevalent in EU countries with excellent health outcomes where equity, universality and social solidarity are maintained. The key is that there is a voluntary contribution which makes up the funding shortfall. This drives quality, giving those on middle and low incomes economic muscle. They don’t have this now.
“David Nicholson said that we couldn’t compromise on the core package, nor on staff pay, nor on quality. But there isn’t any extra money in the system. So where will the funding come from? To discount alternative funding models at this stage does not do the debate justice.”
Further, today DPRG member Dr Michelle Tempest, a psychiatrist and management consultant with experience in both the NHS and the private sector, and Jonathan Guilford, Deputy Editor of the newsletter Healthcare Europa, have published a new comment piece on the subject of health and social care integration, which looks set to be a defining election issue in 2015. This publication, entitled ‘Can the political promise of integrated care be delivered on-budget in a time of rising demand?’ and which can be read here, explores the need to clearly define integration, the institutional barriers it faces and the crucial differences between the nuances of the pre-election integration agendas of the three main parties.
For more information about the Doctors’ Policy Research Group visit their webpage here.