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Tony Levene: Crystal-ball gazing isn’t healthy – but let’s give it a go

Could this be the decade that the NHS is reconfigured?

Mathematical purists – and there are bound to be some among readers – deny we are into a new decade. I have some sympathy with this viewpoint. After all, there was no year “zero” – all the civilisations at the eastern end of the Mediterranean used other calendars and year counting methods as do Jews and Muslims (and many other groups) to this very day. No cricketer ever notches up a century until they get to 100 – then the second hundred starts. Getting to 99 is not good enough.

That’s the numbers argument – it was well rehearsed at the turn of the millennium – but whatever its merits, I have to go with the flow. And that points to a new decade starting now. So will the twenties be roaring or rotten for the protection world?

“Will the twenties be roaring or rotten for the protection world?”

Crystal ball-gazing is not a healthy profession. Get it right and you’re accused of making lucky guesses. Get it wrong and all sorts of opprobrium is your reward. So with the proviso that my call is as good or bad as anyone else’s, here’s a few of my predictions. And like all futurology, basing it on the past helps with credibility.

Perhaps the biggest change in our lives over the past decade was the growth from practically nothing to almost universal acceptance of the smartphone. They are cheap to buy – ignore the £1,000 models and look instead at under £50 – and a decent enough deal costs a tenner a month.

A GP on your phone – better, a GP in your pocket or purse – was a distant dream a decade ago. Now there are several competing services with some advertising on the London underground and similar locations.

You don’t have to read much media to realise the GP service is under severe stress. It lacks recruits, it has ever-increasing demand especially from older people, the obese and the worried well – those who look up their throat tickle on the internet and find they are about to die with some awful disease.

It is supposed to take an average 13 days to get a GP appointment. But unless you are marketing a service, ignore averages. Many GP practices operate a triage system. And many patients never turn up – time is often a great healer.

But it cannot be denied there is potentially a large and growing market for online GP practices. While hands-on can often be the best solution, many patients can be seen remotely.

The difficulty for the online GP is how to get this over to possible patients. Health Insurance and Protection readers already know all about remote GP practices. But ask “ordinary” people, and you’ll soon find that even if they have some vague idea of the existence of these schemes, they know nothing about the practicalities.

As a minimum, they need to be aware of the cost and what it covers. Very few – comparatively – will have doctor services as part of an insurance package. The rest need prices. And affordability. They need reminding whether they can still see the GP they are registered with, that they will be sent for a physical check where necessary, that the online GP can prescribe, and – most importantly – that they can refer the patient to both state and private consultants.

It took decades to wean people off just turning up at the GP and waiting their turn. Played properly, the twenties could be the period of GP on your phone.

The last decade was the time of mental health awareness. Ten years ago, it was barely mentioned. Now it’s hard to go to a protection event without hearing a list of mental health statistics. All that “so many per cent” of people in employment have mental health issues and “it’s a big indicator of problem debt” stuff. If you have not got the message now, you probably never will.

All this awareness is well-meaning and a huge improvement on ten years ago. What the industry must do now is to build on this understanding and ask “why?”. And then ask “what can we do about it?”

The protection insurance world cannot do this on its own. But it can give leads and nudges. We have seen how cancers and strokes and other dread diseases have reduced in both number and severity over the years due to life style changes. We smoke a lot less, we drink alcohol a lot less and even if we eat too much, the more insurable part of the population is at least aware of the damage of over-consumption. Clever drugs and other cures are only part of the solution.

Over the next years, we need to do the same with mental health issues. We should focus on why there is so much stress in society, what can be done to reduce it, and what role can insurers play in this? Is this a case of some employers working people into the ground and expecting others to pick up the inevitable bill? It could be mental illness. It could be violence.

Without this approach, we are doomed to repeat the statistics at meeting after meeting – only each time, they will be worse. It’s our climate change emergency moment.

It is also time to rethink the relationship between private and state medical services. A month or so ago, HCA International’s London Bridge Hospital paid out £2.1m in damages following the death of a banker, aged 57, in 2015 when a vital piece of equipment was turned off accidentally following a routine operation. The NHS pays out millions in compensation as well. Bad things happen in both private and state facilities. But we can no longer sell private health cover on the grounds that it is superior.

“All too often, PMI is sold on the problems in the NHS, anything from queues to drug availability. It’s time to be positive.”

More widely, this could be the decade when the NHS is reconfigured. We need to look very carefully at what we want, consider the strengths and weaknesses of the system and either present a viable alternative or go for segment retreat – where private medical cover is just something for the medium wealthy (the very wealthy can and will self-pay). All too often, PMI is sold on the problems in the NHS, anything from queues to drug availability. It’s time to be positive. We need to come up with reasons for. Not negativity. It has not worked. And there is no point repeating failure.