In part four of TOC’s Focus on Healthcare series, we took a look at how Singapore’s 3M system (Medisave, MediShield, Medifund) measured-up against those of other developed countries. No single healthcare system is perfect, but it is through open and honest examination of best practices (and worst failures), not sweeping statements like “beware welfarism of The West”, that we can make ours better.
In this article, our foreign correspondent checks in on the UK’s national healthcare system, specifically the NHS in England. Described as “the largest and the oldest single-payer healthcare system in the world”, it strained under recent economic uncertainty, but have by and large retained its core principle. It also managed to retain citizen support, who are oddly no less critical of its financial viability.
By Gordon Lee
The United Kingdom’s National Health Service was created in 1946 by the post-war Labour government, as part of the Welfare State reforms inspired by the recommendations of the economist Lord Beveridge. The creation of the service was supported by the three largest political parties at the time.
The founding principle of the service was to provide free healthcare to everyone based on clinical need and not on the ability to pay. Since its creation, the service has been further separated into four individual systems for each country in the UK – England, Northern Ireland, Scotland and Wales.
The National Health Service in England (NHS) is largely free at the point of use, costing the Government £2000 (SGD$4000) for every man, woman and child each year. On top of public spending, the average resident spends £400 (SGD$800) per year on healthcare. This means that the healthcare burden on the average individual is about 20% of total costs.
Public support for the NHS is high. A survey of 1000 individuals revealed that 70% are “satisfied with the current running of the NHS”, and 70% agree that the “NHS is one of the best in the world”. Despite the economic challenges, such strong public support meant that the health budget is only one of two departments which are protected from any government cuts during this parliament of 2010-2015.
However, the survey also revealed concerns over the future of the NHS, with the top concern cited being the lack of resources/investment – this view was held by 39% of those polled. In recent years, the NHS is undergoing a huge reform in a bid to cut costs and increase efficiency.
How to use the NHS
All British citizens, EU citizens, and residents who are legally in the UK for more than 12 months are eligible for NHS care. Individuals register with any General Practitioner (GP), who are then paid by the NHS according to the number and characteristics of people registered with them. The role of the GP is to look after the health of those registered with them, and visiting a GP is free at the point of use. GPs may also refer patients to specialists or hospitals as needed.
Prescriptions currently cost £7.85 (SGD$16) each time, although it is possible to buy a 3-month or a 12-month certificate which entitles one to unlimited prescriptions within that period. A 12-month certificate costs £104 (SGD$210). Any medicine (e.g. injections) which are personally administered by a GP or hospital is free. Certain groups also get free prescriptions – the elderly, young, pregnant, disabled, inpatients, low-income, unemployed and those with a serious long-term condition (e.g. cancer and diabetes).
Besides GP services (where an appointment is generally needed), the NHS also runs a number of walk-in centres to deal with minor illnesses and injuries such as infections, stomach aches, vomiting, minor cuts, bruises, burns and strains. Most of these centres are open 365 days a year and are free at the point of use.
Free NHS hospital care is only available with a GP referral, except for A&E where no referral is needed. Patients have a right to choose their hospitals, and the NHS runs an online comparison service for patients to compare different hospitals based on different criteria.
The NHS also runs a 24/7 health advice service called NHS direct – available online or by calling 111. This is available free and allows users to check their symptoms through an automated system. Users then receive simple self-care advice, whilst more complex cases would get a personal assessment by a nurse (over the phone) to determine the best course of action.
Whereas waiting times used to be a national scandal, increases in public healthcare spending by two-and-a-half times under the last Labour government between 1997 and 2010 contributed to a decrease in waiting times. Today, patients have a legal right to waiting no longer than a maximum of 18 weeks from referral to receive consultant-led treatment.
Because the NHS is largely free at the point of use, the system has always struggled with reconciling demand with supply. Whereas it started out being completely free, a degree of co-payment by patients has been gradually introduced over the last 50 years primarily through prescription charges.
The recent reforms to the NHS has been the topic of much controversy, with interest groups pushing back strongly. To trim costs in the face of grim economic times, the current UK government has implemented a number of measures, including streamlining bureaucracy and distributing the cost burden, to keep the system viable.
It is clear that public spending on healthcare cannot increase by an equivalent amount in the near future, given the economic realities of the day. Meeting the ever-growing needs and expectations of the public with a slower-growing pot of money will be an uphill struggle in the coming decades.