One of the oft-used, reactionary mantras heard in the NHS is, ‘we don’t want a two-tiered healthcare system; one for the rich and one for the poor’. It’s employed by the unthinking to close down any argument, however modest, which attempts to describe the potential benefits of private investment in the NHS.
In Schein’s model of culture, it’s a level 3, ‘basic and underlying assumption’, that brooks no discussion because it’s so ‘obviously true’. It is straight out of the Socialist, totalitarian playbook, which demands implicit (sometimes even explicit) and immediate obedience. But, it beggars the NHS by denying it the additional funding that could come from allowing those who want to, to pay for ‘extras’.
Is there a better way? We’re all familiar with airlines offering passengers wildly different prices for different experiences; from Economy through to First. All the passengers get on the same aircraft and reach the same destination, but those who value the extras on offer, can choose to upgrade for a price.
Ironically, when I worked in France, (generally considered a much more Socialist country than the UK), I discovered that about one third of the total GDP spend on healthcare was private, compared to a mere 10% in the, ‘capitalist’, UK. This higher, private spend largely accounts for the higher total GDP spend on healthcare in France versus the UK; a fact often conveniently overlooked by those who benchmark GDP spending on healthcare. One could say that the French permit an à la carte menu, whilst in the UK, it is strictly, prix fixe!
The French healthcare system, by permitting greater flexibility, is stronger, on almost every outcome measure, vis-à-vis the NHS.
So, rather than advocating for a ‘two-tier’ healthcare system, (which induces an allergic reaction in many so-called defenders of the NHS), the answer is to pursue, more formally than now, an NHS that is far more flexible. This means embracing a ‘multi-layered’ system, with different patient experiences, such as rooms, food and extras paid for either out-of-pocket or via insurance. This type of up-selling and cross-selling could revolutionise the patient experience and at the same time generate much needed additional revenue streams for hard-pressed Trusts. It would introduce genuine and benign competition into the system and make it much more patient-focused. It would be like a proverbial financial tide, lifting all the boats, great and small, rich and poor, alike.
For the NHS to survive another 70 years, the key will be flexibility. If it can’t embrace differentiation, it faces disintegration instead.