In the new millennium, UK society will look very different to the way it does today. Demographic changes will mean there will be fewer young people and more old people and the burden on the NHS will be greater than ever.
Public opinion is divided on how the problems facing the health service should be addressed, but a new initiative is set to find out exactly what people really want.
A mammoth consultation programme is currently underway designed to ask 80% of the population what they think about health issues in the 21st century. And the subject of private health provision is at the core of the debate.
The Debate of the Age, coordinated by Age Concern, has an ambitious agenda. A series of five Millennium papers has been commissioned, designed to analyse the implications of an ageing society. These are Health and Care, Values and Attitudes, Paying for Age, The Built Environment and Work and Lifestyles
. And, as a result, the next two years will see a nationwide debate, taking place through meetings and conferences, as well as through newspapers, television and radio.
The health and care theme is bound to excite a lot of interest. And so it is natural that BUPA should be a key participant in stimulating discussion. The insurer is one of the main backers and has sponsored the Debate of the Age pamphlet, This is about Your Health
. A freephone number and a website are also available to the public. Simon Knighton, debate director, is keen to point out BUPA’s crucial part in making the debate happen: “BUPA is not trying to sell its product through the debate or trying to influence what people say. Nor is it trying to use the debate to get people to buy more healthcare from BUPA.
“Our relationship with BUPA is sophisticated and mature. It is all about the need for people to be better informed about what the future has in store.”
BUPA’s head of public relations, David Bryant, stresses the reasons BUPA has taken such a prominent role in the Debate: “It’s all about getting public involvement between now and the Millennium and getting the public to say what they want. We are involved so that the Debate of the Age has the opportunity to get that information and present it to all interested parties, such as Government, think tanks and health authorities.”
The health launch kicked off in May at a nationally covered public debate between Claire Rayner, chair of the Patients’ Association and Christine Hancock, general secretary of the Royal College of Nursing.
Healthcare rationing was the contentious issue under discussion. And during this debate, Hancock proposed what might be seen as a popular motion: “We believe that access to 21st century healthcare should be free and available at all times.”
Free for all?
Claire Rayner took a different line. She argued against Hancock’s assertion that the country can still afford the NHS.
“I have to admit, with deep regret, that there is no way in the coming [Millennium] or any other Millennium that every citizen of this country could have on demand the free medical treatment they want. New therapies, new electronic and nuclear systems, new drugs, new diseases even, have created a bottomless pit of demand.”
Rayner also demanded thoughts on the future: “And what about inevitable future innovations? New knees and hips are just the beginning, new wrists and fingers and ankles will eventually be commonplace. There’ll be new body organs of every kind, new body fluids, new drugs, new everything the human structure could desire. At a price.”
The event came in the wake of a nationwide MORI poll, carried out for the debate, in which 61% of all respondents wanted the public to have a greater say in deciding which services should be available free of charge from the NHS and which might have to be paid for independently.
The survey also showed three out of four British people believe free healthcare should be available to everyone, whatever the cost in taxation. A total of 44% agreed people should have to pay for non-essential treatment through private health insurance.
Most leading figures in the health insurance industry will find themselves on the side of Claire Rayner in discussions of the issue.
Robin Payne, general manager, business development, at the Exeter Friendly Society, also takes a realistic view of the future of the NHS.
“The NHS knew in 1949, one year after its foundation, that it couldn’t meet people’s expectations. In Utopia maybe, but the cost could be incredible. Free health cover is a perfect concept, in reality it can’t happen,” Payne says.
Assistant managing director at Prime Health, Mike Hall, has a similar outlook and offers a solution to the tensions between the public and private sectors.
“We could forge public/private partnership deals with the NHS in that we invest private money in the NHS in return for them carrying out complex procedures. The private sector purchases high standards of medical cover which is profitable to the NHS.
“And then the private sector could do what they’re good at – day case procedures that aren’t life threatening, procedures that fill up NHS operating slots. This releases valuable resources the NHS could use to get rid of waiting lists in areas like open heart surgery,” says Hall.
He adds: “It is a crazy situation that the NHS says it doesn’t have enough resources and the private sector has too many. If the politicians at the top level wanted to, we could sit down and talk tomorrow. People are running scared from the talking to the private sector.”
Areas of excellence
There seems to be a general consensus in the private sector there are some areas of the NHS which can not be beaten, particularly accident and emergency cases and serious ailment treatment. And a corresponding realisation within the public domain that the NHS is not a never ending pot of gold. Hall is not the only industry spokesman to be advocating a public/private meeting of minds.
Bob Bycroft is chief executive at Medical Insurance Agency Group (MIA Group) and has long lamented the reluctance of Whitehall to engage in debate with private insurers. “Why do I not have a succession of health ministers beating a path to my door?” he asks.
Bycroft cites the wealth of experience of MIA Group and its long standing relationship with the medical profession. Established in 1907, It currently has in excess of 120,000 medical and dental clients and donates all its surplus profits to charities of healthcare professions.
“You will only get a meaningful debate if you have someone from the public and private sectors,” comments Bycroft.
Perhaps the Debate of the Age will provoke Government into action. Its goal is to measure the opinion of the nation and help the Government to understand the health issues close to the public’s heart.
But, as the powers that be have undertaken to listen to the outcome of the debate in spring 2000, it is far from clear which side of the debate will triumph in the end.