December 12th 2014 was declared Universal Health Coverage (UHC) Day worldwide as 587 academic institutions, non-governmental organisations and health charities campaigned for healthcare to be universally available so that epidemics such as Ebola, Malaria and Heart Disease can be tackled, particularly in developing countries. This movement has been inspired by successful healthcare systems in developed countries, which have improved the health of their populations while also boosting their own economies as a result of a healthier workforce. One such paradigm is the UK’s National Health Service (NHS). Founded in 1948 by the Labour party, it is now the largest publicly funded health service in the world, and was recently rated the best health service amongst 12 developed countries.
Since the Health and Social Care Act was passed by the Conservative and Liberal Democrat coalition government in 2012, there has been increasing concern that the NHS will not be a ‘free-for-all’ health service for much longer. We have already witnessed nurses losing their jobs, hospital A&E wards being shut down and surgical procedures being curbed in an effort to meet the government’s demand of £20 billion in savings by this year. It is no wonder, as the NHS actually requires another £30 billion each year to stay afloat by 2020. A study in the British Medical Journal last year showed that private sector providers secured 33% of NHS contracts in the preceding 12-month period . It was even discussed that GP consultations should require a £10 charge, although the British Medical Association rejected this motion. It seems profit will become and increasingly influential factor in the provision of health services in the years to come, thus the NHS may struggle to maintain its status as the gold standard for the provision of healthcare worldwide. This is perhaps driven by an American-style mentality where any socialist system is feared as an attempt by government to control the population. As NHS services are slowly eroded, so too will the health of the UK population, the ability of the UK to remain a world leader in medical innovation, and the strength of Britain’s economy.
So what if the NHS became inaccessible or unaffordable to the poorest in Britain? We have seen the havoc created by private insurance companies in the US and elsewhere, who often reject ‘high-risk’ patients deeming them too costly. Hence the poorest and most vulnerable in society cannot afford healthcare they so desperately need. However other patients are not safe either. Deceitful persons can exploit them due to their lack of medical knowledge. This scenario has been particularly evident in the Indian states of Madhya Pradesh and Uttar Pradesh, where an inefficient healthcare system has allowed exploitative companies to run riot .
Let’s take a look at how universal healthcare has benefited developing countries. There are many examples where good basic healthcare has been provided at a very low cost. In 2001, Thailand introduced a nationwide system where no patient would have to pay more than 60p per visit for medical care, while the poorest quarter of the population were exempt from charges . As a result mortality rates, particularly in children, have fallen while life expectancy has risen significantly. The new Thai health system has also demonstrated that with widely available preventative care and early intervention, the need for expensive treatments and surgical procedures has plummeted. Readily available healthcare is also essential to fight infectious disease epidemics, should one ever arise in the UK. We have seen in Western Africa that if countries surrounding Guinea, where the most recent Ebola outbreak began, had effective universal healthcare systems, this could have alleviated the outbreak or even prevented Ebola from spreading throughout the region. This is why Nigel Farage’s shameful comment on HIV diagnoses in the recent seven party election debate was so short-sighted, in addition to being entirely false. If we were to reject treatment for HIV patients born overseas, we would be leaving the door ajar for HIV to be readily transmitted within the UK population as well as in surrounding countries, facilitating what is already a global pandemic.
There is no doubt that social inequality needs to be addressed to tackle some of the country’s major health burdens, something the major political parties seem unwilling to confront. The poorest in society are more vulnerable to harmful behaviours such as smoking, abuse of alcohol and drugs, and mental health problems. Anxiety and chronic stress caused by redundancy and poverty can weaken the immune system and increase risk of cancer and cardiovascular disease. But a strong universal healthcare system plays a large role in tackling inequality, while benefiting the economy. This has been evident in the once comparatively poor Indian state of Kerala, where universal healthcare and schooling has helped the state achieve the highest per capita income among all Indian states . Cuba has been subject to US sanctions for several decades, but it has one of the highest doctor to patient ratios and vaccination rates in the world, and life expectancies are similar to the US population. Cuba is even able to offer help to other countries by flying out doctors to scenes of natural and humanitarian disasters.
The Lancet recently published a proposed manifesto to improve five key areas in the NHS :
· The currently poor interface between general practice and A&E medicine.
· The modest way child and adolescent health care is delivered.
· End the false dichotomy between mental and physical health.
· Stop neglecting early diagnosis and prevention.
· Act on elderly and social care.
It has also been argued that other measures need to be taken to make GPs more accessible such as extending GP opening hours, and making appointments available online and by phone .
I have already explored how the NHS is vital for the UK to maintain its status as one of the greatest medical innovators in the world . Such innovation is essential to tackle major problems of the future such as the prevalence of antibiotic resistance and treating the ageing population who often suffer from a multitude of conditions requiring careful management. Innovations include the development of genomic medicine and healthcare technologies such as wearable devices and smartphones. In the last five years, the current government has frozen research budgets, resulting in a net loss of funding due to inflation. There is an emphasis on investing in the ‘Golden Triangle’ of London, Oxford and Cambridge, which needs to end. Investing in other parts of the country would not only benefit science, but also health, economic and social regeneration . We also need the NHS to train our future doctors and innovators. However this has been compounded by the recent hike in tuition fees, resulting in fewer applications to university among A-level students.
Climate change is also a major threat to the health of the global population. Insect-borne diseases could come closer to home, extreme heat can kill those with existing heart and lung problems, pollutants can increase the risk of lung cancer heart disease, and the loss of homes and livelihoods due to floods or droughts can cause depression . Such a threat requires action on a global scale. While it is encouraging that the UK has increased its international development budget to 0.7% of GDP, more advocacy work is required by the UK to act as a leader in advancing universal healthcare globally .
So as we reach the final month before the UK’s general election, who can we trust to bring about the changes the NHS needs? We have already witnessed how the current coalition government, headed by the Conservatives, have introduced a culture of austerity and privatisation that has sent pulses racing among ordinary citizens. The results of more encouraging measures, such as a pilot scheme where opening hours in 14% of GP practices were extended, are yet to be seen. In their election manifesto, the Labour party have pledged to recruit 8,000 more GPs and guarantee an appointment within 48 hours. This maybe a far reaching goal as the largest increase in the number of GPs in any parliamentary term in the last 20 years was 5,414, while the last Labour government was only able to deliver their guarantee of an appointment within 48 hours to 81% of patients . However their pledges are a step forward, and could be better than anything we could ever hope for from another five years of Conservative leadership.
Dr. Anusha Seneviratne
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