Rationalising health care: lessons from the U.K.

Doctor Writing On Clipboard“The art of medicine consists of amusing the patient while nature cures the disease.” (Voltaire)

“The NHS is Britain’s finest public service and must be preserved from commercial interests.” (Stephen Hawking)

“The NHS is now at a crossroads – as a country we need to decide which way to go.” (Simon Stevens, Chief Executive, National Health Service, England)

Henry S. Fraser

BRIDGETOWN, Barbados, Sunday January 25, 2015 – The health services in Barbados are to some extent modeled on the British National Health Service, which for many of its 68 years was regarded as a model. But if you google “NHS problems” you get 78.9 million hits! And many of the most recent ones make interesting reading, which it would be useful for us in Barbados to note, with the Queen Elizabeth Hospital and other aspects of health care suffering seriously from the recession.

The NHS official website itself admits that the service is under strain in areas such as hospital care, A & E (Accident and Emergency) and GP (general practitioner) services; in other words almost EVERY area is mentioned except public health, but that’s always the easiest area in which to cut costs and services without immediate crisis or hysterical responses!

The web site recognises the main reasons “for the service reaching this crisis point”: the ageing population (as in Barbados, which has by far the largest proportion of elderly in the Caribbean); lifestyle factors (especially the obesity epidemic and the consequent epidemic of chronic disease complications); public expectations; overuse and abuse of A & E departments (where numbers increased by 3 % in the past year); and rising costs. All of these factors are relevant in Barbados, especially the first two, because our large ageing population, having lived relatively inactive life styles for the past 48 years post-independence, now bear an enormous burden of costly chronic diseases.

And so the shortage of money to pay for the increasing demands DEMANDS that we face the problem, explore the options and design solutions. The rising cost of services, the shortage of money and the increasing demands means that the crisis (that has been said not to be a crisis) will become an ever greater crisis, unless the promised discussions between stakeholders take place urgently. The stakeholders, by the way, should include not only the Ministry of Health and the Barbados Association of Medical Practitioners (BAMP) but the other official health care bodies, such as the Barbados Nurses Association, as well as the Ministry of Social Care and the Barbados Association of Retired Persons (BARP).

Unless we face the issue “fair and square” headlines like those on the web and in British papers will appear in Barbados on a daily basis. Here are just a few recent ones: “The NHS is in critical condition but we can’t say so.” “999 crews are told: Abandon patients – order to leave sick on stretchers if docs don’t show.” “NHS staff are working unpaid to help avert A & E crisis.” “Cuts to elderly aid fuelling NHS crisis.” “Paramedics told: your strike over pay could kill patients.” “20,000 cancer deaths every year could be avoided: old and poor ‘get worse outcomes’. “Patients at risk while NHS fails whistle-blowers.” And the problems of staff cuts, low morale and long waiting lists are repeated ad nauseam.

According to the NHS website, these problems all spell out a huge economic disaster for the NHS, and it predicts that the NHS will become unsustainable, with huge financial pressures and debts. We are in a very similar boat. And ironically, like the British, we don’t seem to want to grapple with the problem and find the most acceptable solutions.

Countries such as France and the Scandinavian countries, which are at the top of the health care league tables, have higher levels of taxation than Barbados, in spite of their greater manufacturing and export potential. We must bear this in mind if we expect such comprehensive health services to be funded by government. The most rational approach perhaps would be a mixture or combination of a specific health levy or increase in National Insurance, a modest and selective fee for service, as in many other countries with a basic National Health Service, and expansion of health insurance. It is also important to point out the further savings available by emphasising the most rational approach to drug selection, one of the cornerstones of my own work with the World Health Organisation, Pan American Health Organisation, the Eastern Caribbean Drug Service and the Barbados Drug Service.

Much can be done. Putting our heads in the sand is not a rational option.

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henry-fraser-150Sir Henry Fraser is past Dean of Medical Sciences, UWI and Professor Emeritus of Medicine. Website:  profhenryfraser.com