by Helen Rainbow, Senior Health Researcher
The expected acceptance of the principle of NHS top-ups by Alan Johnson next week will be a defining moment for the service. He said himself in a newspaper article at the weekend that it is like opening “Pandora’s Box”. Enabling patients to top-up their own care, even if it is only happens in a very small number of cases, shatters the assumption that the service is capable of providing everything to everyone. It heralds a new type of relationship between the individual and the State in terms of funding healthcare.
The society in which the NHS came into being 60 years ago is very different to the one that we live in today. On the whole we are wealthier and more educated, with the internet revolutionising access to information. The last 60 years has also seen considerable innovation in the field of medical technology, with advances leading to previously life limiting diseases becoming more manageable. This fact along with increasing access to information increases demands on health services, and will lead to more questions about what we can and cannot afford.
The introduction of top-ups is a step forward in that it recognises the limitations of the current model, but it is not a wholesale solution to the current pressures that our service is under. The time has come to think big, to consider system wide solutions that incorporate the characteristics of high performing international health systems – insurance incentives and universal coverage. The top-ups debate opens up a space for wider debate of this issue, to identify how the NHS can evolve to equitably meet the needs of a 21st century society.
