MENU
Your location:

What dandruff can teach us about funding the NHS

    This article originally appeared in the Financial Times on 28 October 2014.

    The National Health Service has a problem with dandruff. In 2012 PharmaTimes, a trade magazine, reported that NHS family doctors were fielding 40,000 visits a year from patients complaining of nothing more threatening than an itchy, flaky scalp.

    Statistics such as this one have convinced some people from across the political spectrum that Britain can no longer afford to provide health services free at the point of use. If the NHS charged a modest fee for doctors’ appointments, they argue, healthy people would make fewer unnecessary demands on medical resources that are already stretched – and the resulting revenue could go towards meeting the costs of care.

    Some have gone further, calling for the abolition of taxpayer-funded healthcare. They favour a system where people take out insurance to cover their own medical needs, with subsidies available for those on low incomes.

    However, there is intense public opposition to any proposal that involves charging for NHS services. No major political party supports such a plan. If the worried well are to be prevented from crowding out the genuinely sick in Britain’s doctors’ surgeries and hospitals, we must find some way of influencing their behaviour that does not rely on pricing them out of the waiting room.

    The dandruff problem is far from trivial; it is an instance of the economic principle that people tend to consume too much of anything that is given away free. Nor is this exclusively a habit of the scurfy scalped. Each year 5.2m people a year clog up surgery waiting rooms complaining of a blocked nose.

    At accident and emergency departments, too, the most trivial complaints are among the most frequently seen. Too many people turn up at a hospital suffering from little more than a sprained muscle, a stomach ache, a stubbed toe or minor burns. Some patients are merely drunk and disoriented.

    The number of such cases is not overwhelming, but they point to a deeper truth. The NHS is an extraordinary organisation – but we are not using it as well as we should.

    Take missed appointments. NHS England, which oversees healthcare commissioning, has calculated that the health service spends £162m a year on doctors’ appointments for 12m patients who fail to turn up. Almost 7m hospital outpatient appointments also go to waste, at a cost of perhaps £700m a year.

    Or take the rising number of visits to A & E departments over the past decade. This is often put down to the rapidly ageing population. But a recent study by the Nuffield Trust found that people who attend A & E more than 10 times in a year are typically between 20 and 55 years old. Patients in their 40s are particularly well represented among the regulars. These are the “worried well”.

    Poverty does play a role, but a sizeable contingent of the repeat customers are drawn from the country’s most affluent areas.

    Add up the annual costs of missed appointments and overused services, and the bill to the NHS is at least £1bn a year. This is not sustainable. To change it, we have to make people think twice before they make wasteful demands on the country’s health service.

    In a paper published on Wednesday through the Centre for Policy Studies, Museji Ahmed Takolia and I propose a way of doing just that.

    The idea is simple. Everyone who uses NHS services would receive a statement every year, showing which services they had received and how much they cost. Where cheaper treatment options were available that were just as good – say, visiting a family doctor rather than an emergency room – they would also be told how much this would have saved.

    This initiative would not solve all the problems of the health service. Still, if it changed people’s behaviour and encouraged them to consider the costs of their actions, it could help alleviate the pressure on the NHS without compromising the general principle that you should not have to pay to receive medical treatment. It would encourage people to take greater responsibility for their own healthcare, without making them directly responsible for the financial costs.

    There is one final point. The NHS has a budget of £125bn a year and employs 1.7m staff, yet it still has a surprisingly weak understanding of how and where that money is spent. Healthcare statements would force the NHS to become more rigorous about cost assessment, attribution and control. That, by itself, would be a huge benefit.

    The new report "How Much Do We Use the NHS?" by Jesse Norman MP and Museji Ahmed Takolia can be read here.


    Centre for Policy Studies will not publish your email address or share it with anyone.

    Please note, for security reasons we read all comments before publishing.


    Comments

    Peter Copping - About 1135 days ago

    I have a narrowed right nasal passage and having cleared up my chronic catarrh with the advice of the Mayo Clinic from the web I ienquired about fixing it. I visited at my GP suggestion a diagnosis unit and was advised there the balance of success was not favorable so unlike Ed Milli I dropped the request.
    The catarrh treatment was reluctantant post approved by the GP and I declined an prescription since the cost per occasional treatment as less than 10p.
    On the other hand I do need to discuss my splints with a physio as they trouble me walking to agree a safe exercise programme. I have bought the supports myself on ebay the NHS one having worn out.
    I bring my GP up to date with my personal treatments.

    Comment on This

    Centre for Policy Studies will not publish your email address or share it with anyone.

    Please note, for security reasons we read all comments before publishing.


    Anonymous - About 1135 days ago

    I forgot to mention I have my summary record from the GP and my complete health record.so instant records exist. The problem is privacy from people who want to make money out of me.

    Comment on This

    Centre for Policy Studies will not publish your email address or share it with anyone.

    Please note, for security reasons we read all comments before publishing.


    Jenny Hughes - About 1007 days ago

    You wrote: 'Everyone who uses NHS services would receive a statement every year, showing which services they had received and how much they cost. Where cheaper treatment options were available that were just as good – say, visiting a family doctor rather than an emergency room – they would also be told how much this would have saved.'

    Great idea. But must also look at the CAUSES of why people go to A&E, for example in my case I was forced to go to TWO A&Es out of area because local hospital AND 3 local GPs failed to take any action/examine me/provide care.

    I know I'm not the only one, indeed within my own family the regular GP decided the surgery could do a minor op that )once cut/pumped full of local anaesthetic) they realised they couldn't = op in hospital but totally messed up. GP neglected very serious infection so ANOTHER visit (demanded to see a locum) and at last treatment, but TOO LATE = permanent scarring. Was offered plastic surgery, risks explained as VERY low in 1st appointment then oh, 2nd one all of a sudden HUGE risks, very very odd. And all those wasted appointments and extra injury caused by shoddy work and neglect. SHOCKING.

    And how many patients don't turn up for appointments because lettershave gone astray and not asked to CNFIRM got letter/appointment? NHS data/records and systems are (often, not always) RUBBISH.

    I know I'm not the only one to have turmed up for an outpatient appointment and oh: my medical records couldn't be found, 'sorry' they said.

    And another time I wasn't told enough, not given time to ask questions so had to ask for a SECOND appointment because doc hadn't done his job properly first time.

    Then another outpatient appointment (endocrine) the doc refused to discuss my endocrine problem and when I asked pertinant questions he acted VERY odd: he changed to subject to art (my specialty), it felt as though he was angry I was reasonably well informed and that I dared to ask questions. So ANOTHER wasted appointment and the doc in question didn't act at all professionally, he acxted like a kid and extremely arrogant and strange. How can it be he was allowed to practice and waaste NHS money and my time/energy like that?

    I can't be that unusual and in my wn life (and family) I can report so very many times NHS doctors (and dentist) = 'experts' fell way below the standards we would expect - and I HOPE the GMC and all of us paying for the services would expect and multiply that by millions = waste on a MASSIVE scale.

    So please don't blame just the PUBLIC for waste, look at what really causes the most (and most dangerous) waste in the NHS. We're sick of being blamed by doctors, managers and states for THEIR inadequacies: unfair and cruel. Does this one-sided consistent attack on us (clients of a monopoly - unless wealthy) keep on happening by accident?

    Comment on This

    Centre for Policy Studies will not publish your email address or share it with anyone.

    Please note, for security reasons we read all comments before publishing.