An excellent Editorial piece here from the Lancet of 15th November. No further comment is necessary.
The UK’s National Health Service (NHS) is one to be proud of: free care for all at the point of delivery. But a proposal last week by the Department of Health to allow NHS patients in England who can afford to buy treatments that are not approved for NHS use to top-up their treatment heralds a truly two-tier system.
The existing system allows patients to pay for extra treatment (top-ups) but then they lose all NHS care. The new proposal, which is out for consultation until January, will allow top ups, with the rider that the extra treatment cannot be given on an NHS ward but will need to be administered in a private ward or hospital. The UK Government is clearly embarrassed, not wanting patients in adjacent NHS beds to be receiving different care.
Welfare spending (and health-service spending can be seen as part of that) affects the health of citizens. In a paper in The Lancet last week, the NEWS Nordic Expert Group showed that generosity in family policies is linked with lower infant mortality and that generosity in pensions is linked with lower old-age excess mortality. “Social policies are of major importance for how we can tackle the social determinants of health”, the authors concluded. A Comment added: “At least in the Nordic countries, such policies have been as much about dignity and solidarity.”
Dignity and solidarity are key concepts that must be applied to NHS funding. The decision to allow a two-tier NHS is undignified and divisive. The National Institute for Health and Clinical Excellence, battered this year for its decisions about high-profile drugs for renal and lung cancer, and dementia, is to review how it calculates whether a treatment is cost effective. But the funding of a national health service reaches higher, to the heart of government. This summer saw the UK Government use £400 billion of taxpayers’ money to rescue ailing financial institutions. Vast sums of money can be made available when needed. The government needs to re-align its priorities, or face accusations of moral bankruptcy.