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A fascinating document offering useful possibilities and yet several important topics do not appear.
Healthcare, properly provided, is not and never can be a commercial undertaking. The conflicts of interest, the perverse incentives and the moral hazards are insuperable obstacles. Profit is incompatible with patient centred care and optimal outcomes. The clinician must always be the patient’s advocate within the system and never the agent of capital or self interest.
A simple hypothecated H&SC tax should be augmented by taxes on fats, salt, sugar and alcohol (inter alia) that fully account for all the negative externalities that such factors impose. Taxes on fats, salt, sugar and alcohol should be on a pence per gram basis, charged, respectively, at the point where the materials enter the food chain or leave the factory.
Care must be taken that those HNW individuals who are so adept at avoiding tax do not escape the H&SC tax.
Recruitment and retention of clinical staff requires more than higher pay and better conditions. Huge improvements in morale, quality and productivity can be instantly unlocked by reducing the burden of admin/managerialism/box ticking/etc. Time spent away from direct patient contact by clinicians should be limited by contract to, say, 5% of contracted hours. Managerialism itself needs taming – managers do not always know best and are often seen as agents of government diktat rather than having the patient’s interests closest to their hearts.
The workload that is placed upon healthcare systems has been likened to a pyramid and this can be the basis of a system that redirects scarce funding to higher priority areas. At the base there is a vast amount of small, simple, and low urgency problems that require little more than assessment and advice. Often no treatment is required – simply reassurance. Where simple basic treatment is required, this should be entirely self funded. A schedule of funded and unfunded items can be devised.
How does this work if the economy is shrinking?