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Time to question the Holy Cow

Time to question the Holy Cow
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Discussions on GDPUK forum often stimulate my thinking and my thoughts in this blog are for the nation to consider in 2017. This blog uses dentistry for some of its examples, but is about the future of the NHS, and asks if the marketplace could help development of a different type of health care system, funded not just centrally. I have tried to keep this a short piece, so I have abbreviated the steps for my intelligent readers.

Everyone knows the leviathan that is the National Health Service is creaking. It is a monster which cannot be easily turned. Larger and larger cracks appear day after day.

Yet the Stalinist NHS concept remains a sacred cow for the UK public, and our politicians. Privately we all know the limitations of the system, there are over a million NHS managers, and a gradually lower number of hospital beds. General medical family practitioner services are being squeezed by the combination of an ageing workforce of GPs, over-regulation and personal stress together with negative incentives for younger medical colleagues to join this perverse merry-go-round.

Dentistry has been a different case since the NHS was founded. In 1948, dentists did not sell their practices to the NHS, and continue to own them and therefore fund the capital to provide the country with dental care services. NHS brought in patient charges for dental care soon after, and hypocritically, this has been followed by 60 years of political lip service to the lofty but untrue concept of "NHS - free at the point of delivery".

The public do see their dental services as different, as they have to put their hand in pocket to gain access.

Let us consider orthodontic services. In the last few years, without any national edict, no elected political control, let alone public consultation, orthodontic services, mostly for younger people, are gradually being turned off by the unaccountable powers that be. An Index of Orthodontic Treatment Needs [IOTN] was created, and this classifies the needs of patients, particularly under 18s with developing dentitions. Some children have a low need for treatment, some have a high need. The profession and the public  can understand this. In the good old unrationed days of the NHS, any young person who their dentist felt needed some adjustment to the shape of their teeth and therefore their face, could be treated at no fee [but at some cost to the NHS]. The new standard is to restrict this access for all, by means of this IOTN. The IOTN access hurdle does vary by area, hence a postcode lottery.

But you and I are taxpayers, and when we think about it, should we leave a blank chequebook open at all times for everyone, for tooth straightening? To give an extreme example, say curly hair was seen as an aesthetic problem for young people, affecting them psychologically, should NHS funds be used to pay for straightening hair each month? Or say darkening blonde hair to brown? We would all say no to these items, they are cosmetic, and this standard definitely applies to both teeth and orthodontics, in my opinion.

So those who can afford orthodontic treatment for their lovely child with one crooked tooth nowadays have to pay for this in most areas of the UK. We accept without too much anger, this change has occurred and people will pay privately.

I now carry this across to the rest of the NHS. Imagine the NHS with its massive menu of treatments. Does everyone need everything from that list, or are there some areas that can be trimmed? Or do we leave the trimming to the faceless, unaccountable bureaucrats to facilitate?

But say you, or a close family member needs x or y or z which isn't covered by NHS - it would make sense to have a low cost private medical insurance cover for the aspects not provided by NHS care.

Maybe the tax element for NHS care will be reduced slightly. Perhaps next, a radical Chancellor of the Exchequer will agree to tax relief on those medical insurance premiums to encourage people to use them, which in turn will take more away from the burden carried by the NHS budget.

As the move to the private insurance grows, becomes more socially acceptable, the market will turn towards even better supply of services to compete for this spending on healthcare.

Like the hotel industry now, we know there are 5 star locations in cities and the countryside, where all aspects of substance and service  are better, and at the same time, we all know there are cheaper ways to spend a night. Importantly, in 2017, we all have this choice of hotels, easily accessible, with photos, reviews, and ratings, which in turn drive the market segmentation and survival of the fittest.

I believe the holy cow of the NHS needs to guided  towards this change, allowing the marketplace to develop more low cost yet limited health insurance coverage, gradually focus on saving lives and emergencies, before its black hole of increasingly desperate funding need pulls us all inwards.


Tony Jacobs


2nd  January 2017


Image credit - Philip Daly under CC licence - modified.

Dental Wishlist for 2017 by @DentistGoneBadd
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