Cycling

How do we Close the Gap between Health and Healthcare?

By: Ben Gowland CEO NHS Nene Clinical Commissioning Group @ccginsider
Published: Monday, September 29, 2014 - 09:33 GMT Jump to Comments

The funding crisis in the NHS means we must start a debate on how we can link choices we make to look after our own health with the amount we pay for our healthcare.

The way we pay for health and the way we pay for healthcare exist in glorious isolation from each other.  The financial challenges facing the NHS mean this is not a situation that can carry on. We need to at least start the debate as to how we can bring health and healthcare closer together. If we want even an outside chance of tackling the financial challenge facing the NHS, we have no other choice.

The current system has a clear gap between our individual, citizen responsibility for our health, and the tax funded state responsibility for our healthcare. We as individuals have responsibility for our own health. We manage our own weight, decide how much exercise we are going to take, and decide whether and how much we are going to smoke or drink. At present there is no reward or consequence for any lifestyle choice we make, other than the impact on our own health. 

We fund the NHS through taxation and as such it is free at the point of need to the individual. Our contribution to the cost of healthcare is determined regardless of how well we have managed our own health. While there is clearly a correlation between the way that we look after our own health and our requirement for healthcare, we don’t at present have any system in place for linking the two.

The think tank Reform picked this issue up in its report, ‘Solving the NHS Care and Cash Crisis’. This report recommends ‘a radical partnership between State and citizen’. The first of their seven ‘big messages’ is the co-production of health between the NHS and the individual, with a system that supports more individual self-care and preventative health care. The challenge, they say, is not what the NHS can do to you, but what it can do with you.

But how can we do this is in practical terms? How can we start to link the way we pay for healthcare with the investments we make in our health? What types of options are there?

The Reform report suggests that each person should gain ‘NHS membership,’ which provides a ‘health MOT,’ a focus on the management of long term conditions, and more support for carers.  Membership would incur a fee, which would be collected alongside council tax and the funding used by Health and Wellbeing Boards to expand the capacity of community based prevention services.  Whilst I think this is tackling the right issue, re-describing what is largely the role of general practice and introducing more tax (and so distance from individual responsibility) does not seem to me to solve the problem.

If we put all the drawbacks of an insurance system to one side for a minute, what this type of system provides is a much more intrinsic link between health and healthcare. If an individual smokes or is overweight then the cost of their insurance premium goes up. If I don’t carry out my citizen responsibility of looking after my health, then my taxpayer responsibility (or in this case insurance premium) goes up. 

Whilst moving to an insurance system is not on the cards, there may be mileage in linking tax contributions to lifestyle choices. The Reform report recommends higher ‘sin’ taxes on alcohol, tobacco and sugary foods. More interestingly it says there should be ‘consequences’ of failure to participate in the annual health MOT, although it stops short of linking either this or the results of the MOT to any form of individual financial contribution.

Simon Stevens, Chief Executive of NHS England, has recently proposed a new system for England in which employers would be financially rewarded for introducing schemes to help workers lose weight. Employers already have high costs due to sickness absence, and exploring the role of employers in providing direct financial incentives for staff who make healthy lifestyle choices may be a more fruitful avenue to explore in closing the gap between health and health care.

Another opportunity for creating a link between health and healthcare sits with Health and Wellbeing Boards.  Local authorities can create financial incentives or penalties for citizens, and can link them to local healthcare provision through the Health and Wellbeing Board. Because of the Better Care Fund, the primary focus of these boards is currently bringing health and social care closer together, but its role could develop in future to provide the missing link between health and healthcare.

We have to find a way to close the gap between our choices that impact on our health and the costs of healthcare. We have looked at a few options here, and I am sure there are many others.  There is no easy way of doing this, and the pitfalls in trying to do it seem plentiful, but at least starting the debate is going to be important in enabling us to sustain the NHS that we care so much about into the future.

The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.

Comments

Latest

Outdated infrastructure and an increasingly fragmented market threaten the future of technology-enabled integrated care.

County Durham voters back devolution in the North-East, Sir Digby Jones considers run for West Midlands mayor…

The recent launch of The Mayoral Tech Manifesto 2016 on London’s digital future, sets out a clear agenda…

The manufacturing industry is currently facing scrutiny from parties concerned for its survival. Far from facing…

Almost a year ago, I made some predictions for what would take place in government and public sector customer…

Sheffield, Warrington and Doncaster announce cuts, Lincolnshire is held to data ransom, fight begins for West…

Working for an education charity delivering numeracy and literacy programmes in primary schools, I’m only…

Northamptonshire County Council recently received the maximum four star rating from Better connected after putting…

Historically, the entrance of new generations into the workplace has caused varying levels of disruption. The…

Following another commendation for digital services, Surrey County Council's Web and Digital Services Manager,…

We cannot carry on spinning the roulette wheel that is cyber security, knowing that the “castle and moat”…

This week David Cameron wades into row over £69m of cuts planned by Oxfordshire CC; Stoke on Trent plans…