Graham Ewart
The need to overhaul practices and processes in the NHS has been in discussion for years, but it is not a debate ending in the dissolution of the system.  Graham Ewart, CEO of Direct Healthcare Group (DHG), which specializes in the manufacture of medical devices, products and solutions for patients with limited mobility, shares his insights exclusively with THIIS…

As we head into 2022, we can look forward to a year of hope and healing for the healthcare sector. Over the past 24 months, it has been ripped apart by Covid, Brexit and an ongoing lack of investment. Its fragments are still being pieced together and some may never be repaired, but there are plenty of lessons to be learnt and new, sometimes forced, ways of working which we can take forward with us.

Perhaps the most important of these lessons is the widespread realisation of the dire situation the NHS and healthcare sector has been in over the past decade, and the urgency for overhaul.

As a 73-year-old institution, for the majority who don’t work within the sector, it can be easy to forget just how fragile an organisation it is and has become following years of lacking investment.

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Typically, this realisation only appears in public consciousness when there is a need for treatment – whether it is experiencing long waiting times at A&E or the inability to book the most simple of GP appointments for weeks on end.

Across the pond

For us in the sector however, the need to overhaul its practices and processes has been one we have discussed for years, but it is not a debate ending in the dissolution of the system. It remains our most loved and most envied product. Our NHS offers free healthcare for all and results in higher life expectancy than in the USA, at half the cost, and is an institution we need to protect at all costs.

When times are tough, comparing our system to those over the pond can be tempting, but while the USA’s rate of specialised scans (CT and MRI), screenings (e.g. for breast cancer), vaccinations (other than COVID-19) and operations are some of the highest in the developed world, the American system is among the least accessible, efficient and equitable, with huge inequalities based on demographics.

To put this in context, about 14 per cent of Americans (over 27 million) were uninsured against illness at the end of 2018, causing an estimated 60,000 avoidable deaths (News Medical, 2021).

While the US leads in medical innovation, boasting many of the world’s leading hospitals, it is a system ingrained in financial privilege, rather than fair and accessible healthcare for all.

While I personally would never advocate a US-style insurance led healthcare system, we can and should look to other sectors or peers for inspiration on how our once world-leading NHS – 79 per cent publicly financed from taxes – and our wider healthcare sector in general can improve.

In Australia for example, a tax-funded, free public health insurance program (Medicare) is implemented, allowing citizens to benefit from free healthcare, however citizens are actively encouraged to opt in to private medical insurance, and for high-income families, tax penalties can be charged for not doing so.

While this may at first sound unfair, systems such as these can work to take pressure off the public health system, making it more available for those who cannot afford higher levels of care and freeing up vital space and waiting times, in effect leading to a fairer system.

Tackling health inequalities

Of course, these kinds of set ups are still privy to inequalities, and the universal system must match up to private healthcare offerings to sustain health equalities among all and prevent a two-tier system. Poor public health systems not only affect the poorest and most disadvantaged most severely, but also promote health tourism – much seen in the likes of South America (Chile and Columbia specifically) where excellent services are pressured by those living, and suffering, in neighbouring countries.

Our NHS model is one that is adopted by the majority of countries around the world, but even after 73 years we still cannot say we have cracked it. For those new to implementing universal healthcare for all, it will understandably take decades, like it has and still is doing for us. In Africa for example, universal free healthcare is a right that is agreed to by all but is slow to become a reality.

One thing transcendent across global healthcare is that it must be accessible, whether as an insurance-based system like that in the US, or those which are state provided, like our own NHS and those across the EU and globally.

Income-based taxes

If a state-run healthcare system is reliant on taxes, it is only right that these taxes are based on income and are accessible, not just to some citizens, but to all. In most African countries, the cost of these taxes are unfortunately unaffordable, and national free healthcare for those living in poverty is still a dream. In fact, according to News Medical, only six African countries spend 15 per cent of their budgets on healthcare, and these are yet to achieve universal access to reasonable-quality healthcare.

So while our NHS does have its issues – desperate and difficult ones – we should be grateful for our broken system. We are lucky to have an institution that strives to serve its citizens, which invests (albeit not enough) in future-proofing it for an ageing demographic, and which is envied by many across the globe. We are also lucky that our system caters for not only reactive care, but on preventative measures to improve population health.

In providing the very poorest in our society with the same standard of healthcare as those at the top (through the NHS), we are proving our British Value of mutual respect. Do we need more investment and further research and development? Absolutely. But we have an excellent system in existence, and should never lose sight of the service we have already built to overzealous opinion and negativity. I for one am very proud of our NHS, and feel very lucky to have it.

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