The shadow health secretary makes no secret of her strong, and often uncompromising, opinions. She sparked controversy recently by announcing she would refuse to become secretary of state for health because she would not license abortion clinics.
Ann Widdecombe, the MP for suburban Maidstone, is well known for converting to Catholicism in protest at the Church of England’s acceptance of women priests and is currently planning a campaign for the return of matrons.
In a recent letter to Health Insurance, she revealed that the Conservative Party is conducting a consultative exercise among healthcare professionals to obtain their views on the challenges faced by the Health Service into the next millennium. The following is a preliminary synopsis of the responses.
1. Will patients develop an increasingly demanding attitude? How should the Health Service respond to these pressures?
It was agreed that patients would be become increasingly demanding, their expectations raised by the media, politicians and the Patient’s Charter. Some believed that patients now considered themselves consumers, and felt that personal responsibility for health should be promoted more strongly.
Although increased resources were frequently proposed to respond to this pressure, it was widely acknowledged that some degree of cost at the point of access would reduce patient demand. Small charges for home visits, missed appointments and after hours medical care were suggested.
Many thought the limitation of nonessential treatments was a nettle that should be grasped, with clear guidelines on what should, and should not be available to people on the NHS. Improved patient education to promote personal responsibility and achieve a reasonable level of experience was recommended.
2. How are demographic changes going to affect the work facing the Health Service? How best can we take care of an increasingly elderly population?
It was felt that social change would ultimately be most influential in care of the elderly, with the promotion of family responsibility for their relatives, and community responsibility in caring for senior citizens. The role of carers was seen as integral and often undervalued, with big improvements to respite services recommended.
Many highlighted the need for better integration of social services and the Health Service in the care of the elderly. Increased provision of help “at home” would encourage independence. A role was also envisaged for the private sector in establishing a partnership with the patient and healthcare services to improve care in the community such as in nursing homes and residential care Patient education was seen as a priority in order to stress the need for preventative treatment, and the importance of adequate insurance and pension provision. Some felt patients should make a greater contribution towards expensive home care and residential care when they could afford to do so.
Rationing was seen by many as being an inevitable part of caring for an increasingly elderly population, with a need for rigorous cost/benefit evaluation of treatment.
3. Have we got the right balance between saving lives and improving the health of the living? Can public health be improved and how will we know?
The general consensus was that we do not have the balance right (80% of respondents).
Several respondents stressed the need to balance high-tech treatment with the more mundane, yet often more effective, and cheaper, options. This highlighted a wider need for proper cost benefit analysis of healthcare. Other suggested areas for improving public health included: a major overhaul of mental health services, increased emphasis on family planning, a need to tackle patient non-compliance and the necessity to maintain a free, comprehensive travel advice/immunisation service to an increasingly cosmopolitan population.
4. What mix of skills will the Health Service require? Should training be more flexible? Do we need less or more specialisation?
The most frequently recommended change to the mix of skills in the NHS was for more specialist training for nurses. It was felt nurses had a big role to play in relieving some of the pressure on GPs, and increased nurse prescribing was widely advocated. The shortage of GPs was also seen as a problem that urgently needed to be addressed. A few respondents thought the Health Service contained too many “chiefs” and not enough “Indians”.
With regard to the need for less or more specialisation, opinion was divided. Approximately 60% advocated less specialisation, 40% more specialisation.
Several GPs expressed a desire to easier access to specialists, and for more training from specialists.
5. What changes will occur in the private health sector? How might these changes affect the future development of the Health Service?
Most respondents felt the private sector would continue to grow, and that private healthcare would increasingly “mop up” patients requiring nonessential treatments rationed in the NHS.
It was agreed that the NHS should use the private sector where it was cost effective to do so.
Many foresaw the development of a two-tier system of healthcare. Opinion was divided however, as to whether this would be a dangerous social precedent, or the advantageous removal of those who could afford to pay for treatment, thereby reducing the burden on the Health Service. It was pointed out that the waiting lists constitute the “cost” to NHS patients, which those using the private sector pay to avoid – waiting lists are a tool which could be constructively used by the NHS.
Some believed that an increase in private healthcare provision would lead to increased salaries for healthcare professionals, thereby placing pressure on the NHS to increase salaries to retain good staff.
It was also feared that the poaching of NHS staff by the private sector could lead to other primary health services following dentistry, with increasing difficulty for patients in finding an NHS GP.
The recent withdrawal of tax incentives for private healthcare were seen as unhelpful and short-sighted.
Several respondents expressed concern that the private sector was already “cream-skimming” patients, leaving those considered too high a risk to the NHS. The introduction of genetic-screening was seen as a particular threat and in need of regulation to protect those deemed uninsurable as a result.
6. Is technology usually going to add costs or might it yield savings? Will telemedicine play a serious role?
Most felt technology could reduce costs if correctly implemented and cost-benefit driven.
General scepticism was expressed towards telemedicine, and audio-visual links were felt to offer greater potential than audio only.
7. Will there still be problems at the interface between the Health Service and social care? Should health-related social services come under the NHS?
The answer to both questions was yes, with only a few exceptions.
A current lack of adequate convalescent care was seen as unnecessarily filling expensive hospital beds.
8. How will the hospital service develop in the future? Will there be more large, specialised hospitals linked to primary care centres?
The majority of respondents saw primary healthcare as leading the NHS of the future. Many felt that community hospitals would remain of the utmost importance to the hospital service.
Opinion was divided on the need for more large, specialist hospitals. About half of respondents felt there should be more, half felt there should be fewer. Those who favoured more large hospitals believed that they brought economies of scale, and that larger hospitals with more subspecialty specialisation were advantageous to patient care by providing centres of excellence. Those who favoured fewer large hospitals expressed concern at the need for patients to travel large distances, and the “depersonalisation” of healthcare.
9. How do you see primary care/family doctor services developing over the next 10 years?
Although a few forecast the demise of the family doctor, most envisaged an increasing role for the service. It was felt GP surgeries would be a major area of healthcare service development, offering many of the procedures currently carried out in hospitals, perhaps even offering a limited number of beds. Larger practices were anticipated. Those pessimistic about the future of primary care/family doctor services cited increasing dissatisfaction with pay and a risk that the service would wither due to poor recruitment and loss to the private sector.
10. How different do you believe the Health Service will be, and should be, in 10 or 15 years from now? What will be the most important driving forces driving these changes?
Most agreed that the NHS of the future would and should evolve from the service it is today. There was less agreement however as to what these changes should be. Some for instance advocated the embracing of new technology, while others hoped to see a move away from technology dependence, with a focus on primary care, public health education and narrowing the socio-economic divides. Similarly, views on structural changes to the Health Service ranged from those who envisaged the NHS as providing an emergency-only service, to those who expected to see a primary care led, socially integrated service, offering cradle to grave care.
Many respondents wished to see a shift in emphasis, with the onus on disease prevention and the promotion of personal responsibility for health. The development of primary care services was seen as central to effective health education.
Highly professional, motivated and well remunerated doctors, nurses, midwives and other healthcare professionals were seen as the lynch pin of a good health service. In particular, an increasing role for nurses was widely predicted.
It was felt that if the public valued their Health Service they must be prepared to provide adequate resources to support it in the future – the electorate must decide whether they will pay for a comprehensive Health