"Defining Mutuality; its place in today's society"
Ref 5/01.03.02
Developing our Mutual Health Service
A discussion document. We very much welcome feedback on this
document.
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Introduction
A mutual organisation is one owned by its members and run for
the benefit of its members. Mutual building societies are part
of the personal finance arm of a far wider Mutual movement.
Mutuality is about empowering the individual member and generating
bottom-up ideas for the development of the mutual organisation.
As such "Save Our Building Societies" the pro-mutual
campaign group have released a discussion document on the future
of arguably the most important mutual organisation in the country;
the NHS.
This discussion paper will discuss how the NHS can be better
funded by a closer financial commitment of the user and their
representatives in the service. See in particular sections marked
#
Margaret Thatcher changed the funding arrangements from being
needs driven to money-driven. The NHS used to say how much funding
was needed. Mrs. Thatcher changed this to allocating a limited
budget. Once this was spent there was no more money available.
#Doctors should decide funding for NHS; not politicians
The Funding of the NHS needs to be taken out of the hands of
politicians. I suggest Doctors are the best people to set the
budget. Politicians have different spending priorities from
the rest of us. For example, national parliament buildings and
prestige projects when the electorate would prefer the money
spent on the NHS. Taxability limits the total amount of tax
that can be levied on the population. Politicians are also reluctant
to increase taxes for political reasons. Unless the NHS has
its own funding independent of the Government, political spending
choices may mean that there is not enough of the 'cake' left
to meet the full needs of a National Health Service.
#Develop a sense of "ownership" with compulsory personal
NHS health insurance
We should all be required to have our own personal NHS health
insurance policy. This would give us a sense of responsibility
and more importantly the feeling of "ownership" over
the NHS. This is vital for the well being of the NHS. People
are quite happy to have insurance policies to protect cars,
homes etc. A central committee and council of doctors would
estimate how much their various professions needed and set the
cost of the insurance policy accordingly -free of political
restraints. It can either be a flat rate policy or one with
discounts available based on personal efforts to remain fit.
Some might opt for the second type and be happy to meet a surcharge
to cover extra administrative costs because overall they might
save quite a lot of money. The Government would pay the premiums
of the health insurance policy for those on low net incomes.
Visitors to this country would take out a specially controlled
insurance policy to prevent us been inundated by millions of
people who are already ill.
#How to end postcode medicine- How to allocate resources
The central doctors council would agree how much resourcing
each type of medicine would receive as a percentage of the budget.
Within the General population there are various types of citizen:
young, old, disabled etc, with a wide range of health needs.
The budget would be distributed according to the precise health
needs of the population according to the type of citizen and
their numbers within a particular area. Areas for example with
an older population would score higher in terms of the resources
provided for geriatric care and would perhaps receive less for
maternity care. The endless tiers of management up and down
the country involved in allocating resources for each type of
medical specialty in each region would be unnecessary. It would
all be done with percentages. More resources could be spent
on health care instead of administration.
For example:
Type of Treatment Allocation % of Budget
Cancer treatment 20% of total budget 20B
Heart disease 15% '' '' 15B
Maternity services 15% '' '' 15B
General Surgery 10% '' '' 10B
Other 40% '' '' 40B
B= UK Health Budget divided by 100
General Surgery is allocated 10% of total UK health budget
= £C
In financial terms £C is B multiplied by 10
To calculate how much an EXAMPLE AREA would get for a branch
of medicine such as General Surgery every person in a country
would first be given a personal health allowance. The personal
health allowance (P.H.A.) would be calculated by dividing the
total health budget of a country by the total population. The
P.H.A. would be added to the formula below.
To calculate budget for General Surgery in an EXAMPLE AREA
Age Weighting Population of area Budget
1-20 2 points x 10,000 x P.H.A. = +
20-40 2 points x 20,000 x P.H.A. = +
40-60 2 points x 20,000 x P.H.A. = +
60+ 4 points x 15,000 x P.H.A. = +
Total £million
To differentiate between one type of medicine and another actuaries
would work out personal weightings. One point in the weighting
scale would be the tiniest of fractions. A person of 60+ might
need a personal weighting of 4 points for general surgery, a
weighting say of 8 points for Heart disease and a weighting
of 0 Points for maternity services.
To assist the reader I have put actual numbers to the formula
based on a notional country with a total budget of £500,000,000
and a population of 50,000,000
B would therefore be the Health budget divided by 100 =£5,000,000
The total national budget for General Surgery would be 10B =
£50,000,000
A person is allocated a personal health allowance (P.H.A.) of
£500,000,000 (total budget) divided by 50,000,000 (total
population) = £10
To calculate budget for General Surgery in an EXAMPLE AREA
Age Weighting Population of area Budget
1-20 2 points x 10,000 x £10 = £200,000
20-40 2 points x 20,000 x £10 = £400,000
40-60 2 points x 20,000 x £10 = £400,000
60+ 4 points x 15,000 x £10 = £600,000
Total £1,600,000
Therefore when calculating an areas total health budget it
could be calculated fairly by formula according to the type
of medical services required multiplied by population and the
age profiles (weighting) of the area. Computers would replace
endless tiers of management.
#End the legal liability of the NHS: provide "Patient Guardians"
instead
Provide patients' guardians- professional medical people within
the NHS who can intervene positively if something goes wrong.
If people wish to use the NHS they must give up rights to sue
the NHS. Why should two disabled babies, one through medical
negligence that can be proved and one through fate have different
levels of medical care? Why allow the legal profession to prey
on the NHS? Scrap the community health councils and appoint
a powerful branch of the NHS that liaises with patients and
the NHS to ensure that patients receive the best care. The NHS
really must be seen to deal with those who perform badly. Patients
need impartial high-level professionals within the NHS to intervene
to ensure breakdowns in service delivery are remedied rather
than lawyers who simply alienate people.
#Healthcare for those from outside the UK
Many from the first world to the third seek to use the NHS.
Doctors cannot be expected to discriminate. One cannot blame
often-desperate people doing whatever they can to get the help
they need. The bill for such treatment should be sent to the
department of foreign aid and the Government should automatically
reimburse that department.
#Family Doctors given resources to match their workload
All surgeries should be linked by email to the central council
of doctors. Budgets to doctors should be allocated according
to patient age, disability etc, types of medicine needed. Doctors
with aged patients would have the extra demand on their resources
recognised. The email information would not include the name
of the patient.
#Organ transplantation: How to make more organs available
Many refuse to allow their organs to be given up for superstitious
reasons. i.e. 'What if a person is not really dead?' 'Why should
I do it when someone else can instead?' 'Why should I be bothered?'
etc People not wishing to take part (excluding children) would
sign a self-exclusion contract. However if they ever needed
a transplant they would not be eligible for one. Introducing
the idea of self-exclusion (i.e. patients taking responsibility
for their actions) is perfectly fair and encourages people to
think very carefully about refusing to donate. For many the
current easy, lazy and quick response to requests to carry a
donor card is to thoughtlessly say No! If people wish to say
No they must take responsibility for it. Very careful very public
scrutiny would exist for the handful of carefully and publicly
vetted and monitored doctors able to authorise organ removal.
This would help allay the fears of the public.
Clearly this is a controversial issue and may need some further
consideration. The concept of blood donation is another area,
which needs further scrutiny. Only 6% of eligible blood donors
actually bother to offer their time and blood to the NHS services.
#Hypothecated funding in the NHS -"That which causes a
cost to the NHS, pays for it"
Ring fenced taxes i.e. from cigarettes and other dangerous products
would go straight to the NHS based on the amount of medical
care a products causes. Built in would be a positive mechanism
to make it worthwhile for manufacturers to make their products
safer. Cigarette manufacturers would be encouraged to sell products
with less tar, nicotine and carcinogens. The more dangerous
the cigarette the higher the tax. Tar, Nicotine & Carcinogen
taxes would directly fund cancer, heart and chest treatment.
Taxes on petrol and cars would fund resulting medical treatment
and a/e depts. Safer cars i.e. Volvos would carry less tax.
Sports insurance would be required for dangerous sports to pay
for medical treatment that results. The hypothecated taxes raised
would reduce the level of the personal Health Insurance that
everyone would have.
Sugar taxes could be levied to pay for dental treatment and
to encourage manufacturers to use less sugar in foods and sweets.
Alcohol Taxes to pay for treatment and policing. The rate of
tax is levied according to the percentage of alcohol in a drink
multiplied by the size of the drink. Local Police forces would
receive significant amounts of new resources from this tax to
police increasingly threatening town centres caused by drinking.
Security of Hospitals. The safety of NHS staff is paramount.
A new specialist NHS constabulary is needed to provide this.
The new specialist NHS constabulary (similar to the British
Transport Police) would be funded by the alcohol tax. This tax
would also pay for state of the art security equipment. Serious
or persistent offenders against NHS staff (with rare exceptions)
would forfeit their right to a NHS health insurance policy and
would be banned from receiving treatment from the NHS. They
would have to go private.
#NHS staff pay and conditions
All grades of staff would have an immediate and significant
pay rise. You get the best from employees by really looking
after them -not by penny pinching.
Lower rate of direct tax for NHS workers?
Allied to this the Government should consider whether different
professions in our society should be subject to different rates
of personal taxation. In which case NHS workers would be taxed
at a very low rate.
Local authority housing for all NHS workers
A good way of improving the standard of living for health care
workers would be to make all NHS staff eligible for immediate
local authority housing when they work for the service. If housing
association properties were used the rent level should be no
higher than those of local authority housing through the use
of a subsidy from the Health Insurance budget.
Notes: How to maximise housing stock for NHS workers and minimise
rents
The most efficient way to keep rents low would be for Government
start up grants for all new housing association schemes to revert
to 100% from the current 50-60% (so that new developments are
not subsidised by rents as they are at present). (This would
actually save the Government money in any case because non-working
tenants would claim less housing benefit to pay lower rents.
Speak to the Joseph Rowntree Trust)
The amount of available social housing stock could be maximised
by ending the right to buy, or if it is politically easier to
do, convert all social housing providers into charitable housing
trusts where the charitable status prevents the purchase of
stock. More controversially exacting standards of behaviour
could be required from existing tenants. For example if a member
of a household committed a criminal offence, harassed their
neigbours in any way, were noisy etc then the household would
be evicted. This would be hugely popular by long suffering council
and housing association tenants and estates would at long last
become havens of peace and tranquility. Many homes would become
available for NHS workers.
Stop raiding hard-pressed third world hospitals to provide
NHS nurses!
The NHS would end the recruitment of staff from abroad except
where staff fled their countries for their own personal safety
(including refugees). In some parts of the world i.e. Southern
Africa and Russia law and order has broken down and we should
allow nationals from such countries make a new start here. Where
we have used staff from abroad we should refund the countries
they come from.
#Health Taxes on food to encourage healthier living
Fat taxes should be introduced to encourage people to eat better.
Money raised should pay for dieticians, sports facilities for
the obese etc. The Government should ban extremely unhealthy
foods, reduce salt in foods by law and force burger bars to
cook their food in more healthy ways; our young in the particular
are currently eating very unhealthy food.
The NHS should return to areas of medicine it seems to have
abandoned
For example back pain is a major health problem today but resources
are inadequate. Many more specialists in back problems are needed.
Currently patients do not know whom to believe when it comes
to treatment for their backs. Osteopaths, chiropractors, physiotherapists
all have their different take on the subject. This is not acceptable.
In all areas of medicine patients must be able to rely on one
lead doctor or therapist to advise on treatment and that person
must be available in the NHS. The NHS should move back into
branches of medicine such as dentistry, chiropractic, osteopathy
etc that it seems to have abandoned and where patients have
increasingly been forced to go to the money driven private sector
to get treatment.
Private therapists & medicine in the private sector
This country is awash with therapists, counsellors, and hypnotists
often encouraging an unhealthy self-indulgent attitude to problems.
Often seen by particularly vulnerable people. Private Therapists
and the like set their own often-exorbitant rates paid for by
(often) desperate and vulnerable people on low incomes (if they
are off work sick). Sometimes the therapist can have more problems
than their client but have have svenglai hold over them. They
set the charge, and then manipulate their clients into paying
it. "You're worth it dear" etc. There is lack of control
over them. They also have an unhealthy financial incentive to
prolong the treatment. The NHS need to be more involved than
it is at present. It should also be able to supervise at various
levels and ways most health care in this country.
Therapists should only be allowed to practice if they sit stringent
NHS exams and become part the NHS. At present you can play around
with someone's mind or feelings with the minimum of qualifications.
When they treat someone they must do so as part of a treatment
team headed or supervised by the family doctor and local health
centres. (Some considered the NHS might make exceptions to treatment
control). Extra resources would be given to the local health
centres and doctors to allow for this extra work.
Rates of pay and terms of employment and the treatment of patients
for all alternative medical parishioners should be set and policed
by the NHS.
Psychological screening of health professionals
The health service should ensure that employees are screened
psychologically. This is particularly important for psychiatrists
and therapists etc.
Ethical examinations
Perhaps doctors need to sit 'ethical' examinations?
Mentoring to replace the social work culture
Today's society needs mentors, life coaches and role models.
The concept of the 'social worker' is outdated and should be
replaced by sound people from very different backgrounds and
experiences to the traditional 'social worker'. The vulnerable
and the weak should be empowered and led forward by the example
and close support of exciting, talented, interesting, motivated
people from large corporations, banking, and the media to name
a few examples. To show the vulnerable what the brighter side
of the world is.
What they might aspire to. Up not down. What they can make
of themselves. Secondments and fixed term placements could be
considered. The vulnerable and the weak need a leg-up not a
leg-down into a course of self-pity, re-inforcing their view
of their place in the world (at the bottom) and their low self-esteem
and morale. At the moment it is a case of 'In the world of the
blind the one-eyed man is king'. This really must stop and the
weak and vulnerable must cease been perceived as a career opportunity
for graduates with soft social science degrees.
Spa centres set up to provide breaks for people including NHS
staff and public sector workers. Every doctor and nurse would
be eligible for two weeks in a spa to recuperate on top of his
or her annual leave.
#Mutual funds for local healthcare
Local communities should be able (and even encouraged) to raise
extra resources for their medical services in an organised way.
Local mutual funds should be established for this purpose.
Paying to see a GP not recommended
We suggest that it would not be helpful for patients to pay
a nominal sum i.e. £10 to see their doctor. The money
raised would be small compared to the real costs and it would
generate administrative costs. Paying to see your Doctor would
discriminate against the poor, encourage some not to see their
doctor when they should, (particularly men) and perhaps most
seriously of all there would be a danger that some patients
might feel they had a right to 'get their moneys worth' from
the doctor. This could put greater pressures on already overstretched
GPs. Some patients might be encouraged to visit their Doctors
more than they need "because they were paying". Doctors
might find that there was a significant increase in time wasting
patients. Delays in treating some patients might mean that later
healthcare was more expensive as well as possibly less successful.
Supplementing the NHS workforce with Workfare
The NHS is labour intensive. All benefit claimants should be
available for work where they will not undermine the job security
or wage rates of existing employees. The public sector is ideal
for this. Improving cleaning in the NHS is a priority. The cleaning
staff could be hugely augmented with workfare. Standards of
work would have to be high otherwise benefits would be ended.
The privatised cleaning contracts should be ended and existing
cleaners could become supervisors. Disabled benefit claimants
would be found employment such as in workshops producing equipment
for the NHS.
(Workfare could also be used to provide personnel for the other
industries like the Railways? Selected companies could purchase
workfare labour from the state.)
An immediate end to discrimination of treatment in the NHS
All discrimination of treatment in the NHS on the grounds of
disability i.e. Downs Syndrome and age i.e. over 70s must be
made illegal and against the law of the land. All discrimination
is quite wrong. Those who suffer it are usually least equipped
to fight back. People over 70 may have contributed more to the
upkeep of the NHS than younger people. The way we look after
those with Downs Syndrome is a good indication of the civilised
nature (or not) of our society.
Aspirin
Every home, shop and public building would be required to have
an up to date bottle of Aspirin, with simple instructions when
to use them. People would know that if they suffered chest pains
they could find aspirin easily and this could be very helpful
medically.
Medical aid
We should play a leading role in providing medical care for
the rest of the world. Doctors might serve abroad on a voluntary
basis. Reconditioned equipment might be given to other countries.
We should build massive factories to mass-produce medicines
for the entire world, at a peppercorn cost met by our country.
In my view racism extends to our failure to stop the massive
suffering in other countries. We should be honest with ourselves
that to some extent some counties are not helped because of
the colour of their skin as well as our lack of a 'World Vision'.
#Royal Commission on Medical and Gene Patents
We should set up Royal Commission to debate how much we can
allow companies to charge for for medicines. In theory a corporation
holding patents on medicines or genes could blackmail a society
into paying large sums of money before treatment can occur.
We must for example not allow any company to ever charge us
more for a drug than they would for another first world country.
The Royal Commission should discuss whether it is permissible
for a country to cancel or place restrictions on a patent in
the national interest.
The Greeks believed that knowledge already exists waiting to
be discovered. Is it right that the first 'explorer' on the
scene can hold the rest of mankind to ransom? In effect levying
a form of 'danegeld' from a society in return for the use of
discovered treatments or medicines.
#The Future: What we might aspire to:
· We should expect to be able to provide the best health
care in the world (not half way in the 'league') and lead breakthroughs
in new treatments.
·
· Patients with life threatening illnesses must be fast-tracked
for immediate healthcare.
·
· The best doctors in the NHS must be used to treat the
more serious conditions. Not carry out easier treatments in
the private sector to earn the salary they should already enjoy.
·
· People needing treatment to return to work quickly
should be fast-tracked.
·
· All NHS workers and their families should be fast-tracked
in terms of treatment.
·
· We should provide centres of excellence and treat the
whole person. Funded in the ways described.
·
· In the long run a large increase in research budgets
will lead to savings in the health service. (As well as giving
today's sick people hope, which can be beneficial in it).
·
· One day the original idea that health care costs would
come down as the population becomes healthier may be realised.
If we could cure cancers and killers such as AIDs, develop regenerative
treatments for spinal injuries large savings can be made.
·
· In the future more resources may be needed for care
of the elderly so it is worth considering whether there are
ways of first reducing illness among the general population,
i.e. reducing smoking and obesity, always looking for the 'knock
out blow' for any illness. i.e. a vaccine for HIV.
·
· We should ring fence some resources for the 'quick
cure' field of medicine.
·
· We should set ambitious targets and aspire to be the
best in the world in developing new medical treatments.
·
· We should be confident that if we apply ourselves with
sufficient determination these goals are achievable.
·
· A properly funded NHS can be not only a national asset
but also a world resource. Lets go for it!
Bob Goodall
·
