Saturday, January 21, 2006

NHS Charging

The NHS Blog Doctor writes an excellent blog, charting his daily experiences as a GP in the NHS. It is witty, well written, and does an excellent job of showing the dangers of a target-based approach to healthcare. Some of his conclusions, however, I just can't agree with. This is particularly the case when he comes to the subject of NHS charging.

People have to understand the cost of healthcare and they have to contribute to it directly as well as by taxation.There needs to be a front end charge. A charge at the point of entry. Furthermore, there needs to be a charge towards the cost once inside the system.

In the last couple of days, I have had to go to the doctors a couple of times - routine administrative matters rather than specific instances of ill health. Both times, I have had lengthy waits once inside the surgery. I don't particularly begrudge these, because I'm well aware one of the problems of "waiting lists" is the fact that before you see a patient, for whatever purpose, you have no idea how long you will need to see them for. Sometimes you can be sent on your way pretty quickly; other times the problem is far more complicated. A 10-minute appointment will rarely take ten minutes. If my appointed slot overruns, then as long as I am confident I am getting good treatment, I do not begrudge it.

If, however, as Dr Crippen suggests, I would be charged £25 for the doctor's appointment (and, presumably, something similar for my follow-up appointment for blood tests the next day), then I would begrudge the wait. If I'm paying a not insignificant amount of money, I expect to be seen when I've booked the appointment. This, of course, would be terrible for healthcare. Either there will be a lot of angry patients, with the health service falling in the eyes of the public, or there will be fewer appointments granted so that people will actually be seen on time. Which will have a knock-on effect on the availability of health care, and, most likely the standard given out.

I agree with Dr Crippen that changes need to be made to the NHS; unfortunately, I'm not sufficiently wonkish to know in detail where systems can be changed. Although trusting doctors more, and giving more power to local districts seems to be a logical idea (not too local, though!). One thing I am loathe to cede in the NHS, though, is a system of charging, because that will damage the nation's health. If you have to pay for a GP appointment, you only go to a doctor when you are badly ill - and probably you will cost a lot more to deal with because of that. (I must admit to having been fortunate enough to have had a doctor when I was growing up who urged us to get an appointment whenever we felt ill, so on the one time it was serious we could be treated swiftly).

Economising on doctors appointments as a conscious choice of policy is something that sits uneasy with me. For all the faults of the NHS, the principle of free universal healthcare is not a bad one. With the rising cost of medical treatments, making decisions on the priority of different treatments must be made, of course. Taking a course of action that will most likely lead to poorer upfront healthcare is something that may well increase costs of healthcare, however. There aren't easy solutions to tackling the problems of the NHS, and I suspect Dr Crippen's solutions are really an expensive placebo.