Dr Teck Khong is a Leicester GP and a forensic physician for Northamptonshire Police who contested Bradford North at the 2005 General Election. He is on the Conservative Party's approved list of parliamentary candidates.
Proposals for health policy changes are conventionally driven by budgetary considerations. This approach to financing the nation’s healthcare is complicated by a second major handicap of government management – adherence to certain anachronistic aspects of the NHS.
By a combination of nannying, removing the financial freedom of choice and perpetuating the grip on procurement and provision of healthcare services, successive governments have stifled the development of a genuine and an ethical market economy in health. This latter objective is mismanaged on the one hand by haphazard privatisation and on the other by disengagement with the professionals who are the mainstay of the NHS.
To stop the present inexorable descent into chaos, our health system should be revived in line with plans for major overhauls in other aspects of the national infrastructure – the pledge to small administration, the inculcation of individual responsibility and the support of personal choice.
Setting funding priorities
It is often said that a dominant tax-funded health system is the most fair and efficient, but the present system is fraught with a lack of accountability and transparency of application. There are widespread abuses by non-taxpayers that undermine this precept of equity.
Leading the transformation could be the introduction of individual contribution to a dedicated health account which includes appropriate incentives, such as that found in Singapore. This effort would be matched by the NHS taking care of uninsurable and catastrophic conditions. Such a proposal is not a renunciation of the founding philosophy of the NHS; it merely reiterates the tripartite compact between the government, the British citizens and the healthcare providers.
It would also declare in principle what the British public can reasonably expect by creating the right environment for personal responsibility and preferences so that the most important elements that matter are neither inaccessible nor unaffordable. The medical and dental professions should be vigorously realigned to be directly accountable to their patients but not necessarily through subjugation by encouraging the wholesale entry of commercially based healthcare companies as such a move could risk cartelisation. A consequence of encouraging personal responsibility would be a reduction in the cost of health and social care as this becomes leaner and more effective.
Defining a unified medical service
It was clear at the birth of the NHS that it was a medical service. It is now a ‘healthcare’ service that covers a vast constellation of entities some of which are only remotely linked to treating illnesses so it is little wonder the NHS is over-stretched and its expenditure keeps surging skywards. The main constituents – the ‘raw materials’ (medicines, investigations, hospitals), the ‘workers’ (doctors, dentists, nurses, pharmacists, etc) and the huge army of superfluous ‘managers’ employed to oversee the multitude of activities (a sizeable amount of which has no importance) – are only the more visible parts of the NHS expenditure. When such things as the much vaunted IT system and the impact of failure (eg, litigation) are factored in, the health system we have is unsurprisingly unsustainable.
Enormous wastage and misspending apart, the most inane fact about the NHS today is the separation between primary and secondary care and the ridiculous tug-of-war for funding. In 2000, I proposed the integration of GP and hospital care, details of which were presented at the Policy Forum on Health in 2003. Such a unified medical service that responds directly to patients would become the backbone of a more focused NHS, which in turn would have a greater chance of becoming quality orientated, more effective and more cost-efficient.
Reversing the trend towards homogenised professional mediocrity
The way compassionate and clinically astute nurses and doctors work is never fully understood or appreciated by non-medical people, let alone by the government. As a consequence, rules and regulations take no account of a natural devotion to vocational excellence. More often than not, managers’ actions conspire against seamlessly smooth service delivery and compassionate care. Remuneration formats that purport to reward quality are ironically subversive by encouraging financial considerations over sound professional care; perverse and nonsensical incentives abound – payment for checking smoking habits and enquiring about ethnicity are just two examples.
As doctors are trained in risk assessment and management, their decisions should not be over-riddened by manager-generated cost-based directives as these only distort their sound judgements. Cost containment is a natural consequence of clinical excellence. Removing the repressive effects of targets would also allow scientific flair to flourish again and the resultant advances would benefit patient care.
Correcting flawed links to the health system
Our servicemen in theatres of war deserve the best care when they are injured. Similarly, the workers who keep our economy alive and the wheels of our shrinking industries moving should also be similarly cared for. People with a sound work ethic do not want to be off sick for longer than is necessary, yet the NHS and the benefit system do nothing to assist early return to work. The entire system of benefits needs a ground-up revamp; care needs to be more responsive by involving employers in the healthcare process and GPs with their close patient rapport should be removed from the invidious position of making statements that tantamount to financial adjudication.
There should be greater effort to reduce dependency on benefits matched in synergy with substantial assistance in re-training and re-employment. If we are to be competitive in the global economy, we should not countenance the large numbers of people who are on incapacity benefit for the flimsiest of ‘health’ reasons and ‘medicalised’ excuses, many of whom are young people who have either done little or no work at all. David Cameron has the right approach on this whole matter.
A future Conservative government should not simply advocate pluralism in the provision of medical services and it should also not be afraid to implement a fresh and relevant interpretation of a health system. Indeed, as presented here, the next phase in the evolution of our health system should be the encouragement of personal and organisation-based initiatives in the procurement of medical services.
With 30 years’ experience in healthcare, I am relieved that our Party will be addressing the failures of flawed Labour health policies. Crucially, there is room to develop the necessary strategic plans that will deal with the challenges of caring for our nation’s wellbeing.
