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Regional differences

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Article 3 of a 3 part series on the NHS. Co-authored by Dr Aisling Koning

Original illustration for Healthcare-Arena by Fran Orford

NHS in England is facing unprecedented challenges: a prolonged funding squeeze alongside a changing burden in society’s healthcare needs has put intense pressure on services and finances. As Healthcare Arena described in Part I, since its inception, the NHS has constantly been subjected to cutbacks and reorganisations by the government, who many believe are focusing more on cutting costs as opposed to investing in a business.  A key problem may be that NHS is framed as a problem needing fixing, instead of an asset (Part II).

The current dispute between politicians and junior doctors over extended working hours is a case in point, highlighting political incompetence and mismanagement of the NHS. Politicians have the audacity to claim the doctors’ primary concern is loss of earnings when they themselves preside over the scandalous waste caused by agency nurses. It is indeed likely that many more people would trust doctors more than politicians, after all, who would you trust with your health?

Funding, transparency and Education

Any business needs investment to flourish. Unfortunately, there is currently no political party with a plan to fund the NHS properly for the future. The equation is simple: if the NHS is to survive and flourish we must pay more, alongside improving efficiency and management.

Because healthcare is free at the point of delivery does not mean that it is free. However, generations have grown up with this impression and expectation. Therefore, regarding funding of the NHS, the lack of transparency on personal contributions leads to confusion for the majority. The proportion of an individual’s national insurance and general tax contribution to the NHS, pension or social care remains largely unknown; some feel that there is no personal connection with financing all three; many people are not aware that their employer also contributes toward their national insurance contribution. Health and social care are closely related and should be managed as such.

A system that allows individuals to see how much they have contributed could have a significant impact. This could be the starting point for dealing with the reality that the NHS cannot survive as a first class service in the long term without a significant increase in funding.

A core solution to properly funding the NHS, and social care in the future, lies in education. A large increase in spending and social care, funded by increased contributions by individuals that are fully aware – and proud of their contributions – could bring significant improvements in health and social care. Indeed, there may not be huge resistance to such increases, you Gov polls in April 2014 demonstrated that 48% of individuals would be happy to increase national insurance contributions if they were ring-fenced for the NHS. This would facilitate sensible discussions on the methods for increased funding, including top-up contributions schemes etc.

Without any political party proposing meaningful solutions to sustaining, let alone improving the NHS in the next decade, this funding must come from some form of taxation; the future of the NHS is dwindling. The Scottish National Party (SNP) and Labour refer to cutting trident and defence spending to reinvest in other areas including healthcare. There is a real need for reality on funding healthcare. This concept of juggling budgets is ingrained in backward political thinking and often counter-productive because it does not address the real underlying issues. There is an urgent need for reality on funding healthcare.

Continued efficiency and prudent financial management are vital but clearly cost savings alone are not enough. This should be achieved with a cooperative, fully-inclusive management policy that is transparent, instead of continual confrontation.

Variation in NHS across the UK

As described in Part I, the universal availability of healthcare underpins the core principles on which the NHS is based. In Scotland and Northern Ireland, the NHS provides both health care and social services, where as in England and Wales the NHS provides healthcare, and local councils provide the social services. However, between the UK’s four nations ­– despite similarities and shared history, there are considerable variations in areas such as health outcomes, spending, staffing and quality (1). Unequal regional access to treatment and prescription charges ­– for some but not others, undermine the principle of universal accessibility.

In Scotland, political mismanagement of the NHS has been exacerbated by devolution. This has resulted in the unnecessary creation of regional versions of UK-wide initiatives: Healthcare Improvement Scotland, the inadequate version of NHS England’s National Institute of Clinical Excellence (NICE); and their equally substandard procurement system, Healthcare Innovation Portal. Owner of Pentland Medical, Stewart Munro, commented on his own personal experience after approaching both NICE medtech and HIPP with one of his products, “I have tested both the NICE medtech programme and HIPP with one of our products. The NICE experience was professional and worth testing. The HIPP experience was clearly inferior. I would add both organisations declined to adopt the product.” He added: “NICE at least explained their decision after due consideration, in a reasonable timescale. HIPP dismissed the application after basic form filling and took a ridiculous time to respond.”

The future of the NHS

The UK’s ageing demographic, increases in non-communicable illness (like diabetes and obesity) and the requisite cost of their prevention and treatment, plus the cost of technological advances, are all new challenges facing the NHS. There is a need for a system of funding that is directly related to delivering a first class healthcare system. The NHS is capable of providing this, however without investment, continuing on the present course will lead to the terminal decline of the NHS within the next decade.

Fortunately, all is not doomed, The Five-Year Forward View was developed as a five-year plan of how to close gaps in funding and quality of care in the NHS (2, 3). It describes national, and local models to support more efficient healthcare delivery, disease prevention, models of service delivery, and integration of services. Its delivery, however, is dependent on fundamental changes in the NHS. While there has been overall consensus on the broad models, change has been slow. Now, more than ever, we need a new, systematic and comprehensive approach to supporting and implementing change to health services, from simple improvements to more radical transformation. With this in mind, the King’s Trust has set out the need for an annual £1.5bn Transformation Fund for investment in new types of care and robust implementation, aligned with more practical support (4)

Being a human endeavour, the NHS will never be perfect. It does not deserve to be treated as a pawn by incompetent, self serving, feuding political factions. The NHS is arguably our greatest national asset and many people still proudly contribute to its running with the hope of seeing it flourish.


If you would like to comment on any of the issues raised by this article, particularly from your own experience or insight, Healthcare-Arena would welcome your views.



  1. http://www.nao.org.uk/wp-content/uploads/2012/06/1213192es.pdf.
  2. http://www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf.
  3. https://healthcare-arena.co.uk/the-nhs-goes-back-to-the-future-in-2015/.
  4. http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/making-change-possible-a-transformation-fund-for-the-nhs-kingsfund-healthfdn-jul15.pdf.


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