Free NHS cannot survive, doctors told

Published on Sunday 21 June 2009 23:13

FREE care for all on the NHS cannot continue indefinitely, doctors will be told today amid calls for a major debate on the future funding of the health service.

Growing pressures from an ageing population, expensive new treatments and the impact of the recession mean that "something will have to give" if the NHS is going to survive, the Royal College of Physicians of Edinburgh (RCPE) will hear.

The Scottish Government said it recognised the challenges faced by the NHS in the future and was building a strategy to tackle them.

Last week, the chief executive of the NHS in Scotland, Dr Kevin Woods, also admitted that the current economic climate posed challenges for the NHS. The RCPE conference – "Rationing, Charity and Private Support: How Much Longer Can We Afford the NHS?" – will hear from speakers discussing the timescale in which Scotland and the rest of the UK can realistically continue to fund the NHS, and particularly free care for all.

Growing pressures on the NHS include more expensive drugs becoming available which it cannot afford for all patients. This has led to the health service allowing "top-up payments" for people to purchase drugs privately which are not approved for NHS use.

But this has caused concerns of a two-tier system where some people benefit if they are able to pay for treatments.

Increased life expectancy, the ageing population and rising rates of obesity and alcohol misuse are also issues for the NHS.

On top of this, the RCPE said the recession was expected to put significant financial pressure on the NHS. As well as a reduction in public spending by governments, the voluntary sector – a major support to the NHS – will see donations drop.

Dr Stuart Rodger, who organised the conference, said: "Rationing of NHS treatment is a very sensitive subject and clearly goes against the founding principle of the NHS which sought to provide free care for all at the point of need.

"Faced with limited budgets, the NHS cannot indefinitely continue to afford to fund free care for all."

Dr Rodger, a kidney specialist based in Glasgow, said the NHS faced growing expenses in a number of areas, including the new generation of increasingly expensive drug treatments coming on to the market, on top of growing population needs.

"It is clear this situation is not sustainable financially, particularly when taking into account the anticipated impact of the recession on the NHS, and that something will have to give if the NHS is to survive," he said.

Dr Rodger said doctors wanted clinical decisions to be based on need, not money, but a debate was required.

"Whatever changes people might suggest, we'd still want the NHS to provide care that's free at the point of delivery for its core issues," he said. "It's just a question of whether there are some things the NHS shouldn't provide."

A Scottish Government spokeswoman said: "The Scottish Government recognises the pressures faced by the health service and is working to deliver a continuously improving and sustainable NHS in Scotland.

"We recently set out proposals for a Quality Strategy for NHS Scotland, which details plans for patient-centred, clinically effective, safe healthcare."

HEALTHY OPTIONS

1 The NHS as it is now – care free at the point of delivery and based on clinical need, not the ability to pay.

2 The voluntary sector – charities have previously been under-recognised in their role in supporting the NHS, such as end-of-life hospice care. Potentially, in the future they could be asked to provide even more, despite their funding streams also starting to dry up in the recession.

3 The private sector – this could include more people taking health insurance, as happens in the United States. The private sector could also provide more NHS care, as has been happening in England, though it is not clear whether this saves the NHS money.

4 Top-ups – core treatment still provided by the NHS, but extra elements such as drugs not approved for NHS use paid for by the patient.

5 Nice extras – are there services currently provided by the NHS, such as complementary and alternative therapies, that could be paid for by someone else?