The Wanless report in 2002 was one of the most significant health policy reviews in recent times. Looking forward 20 years, it was an honest appraisal of healthcare in the UK, recognising that not enough money was being spent. Health outcomes in this country compared badly with those in other Western countries.Since the report was published, the Government has tabled more money for health and embarked on a substantial agenda of reforms. To date, that agenda has focused on provision and has clearly identified a role for the private sector. By 2008, the UK’s total spend on health as a percentage of GDP will be nearer to OECD/EU average levels. However, the percentage of that coming from the private sector in terms of corporate and individual contributions will be well below that of other developed countries. Can the private sector make a greater contribution in the future? Yes. Today’s healthcare landscape is changing and the significant role played by the private sector will grow as it takes an increasing amount of weight off the NHS. Thirteen per cent of the population currently have private medical insurance, with a further five or six million people taking out critical-illness or other health protection policies. The use of the private sector to carry out NHS operations will double in the next five years, with 3bn being spent to pay for 1.7 million operations. Tax revenues paid by the private sector would alone fund some 40,000 newly qualified nurses. In the last year, private medical insurance saved businesses 2.5 million working days which would otherwise have been lost to illness and this is just a conservative estimate. When you factor in the savings delivered by rehabilitation back into the workplace for employees on long-term sick leave and reduced costs due to ill-health retirement, the benefits are much, much greater. Research reveals growing public acceptance of the private sector playing a greater role in the nation’s healthcare. Ninety-three per cent of people polled for Bupa had no objection to private hospitals treating NHS patients if it meant faster treatment at no extra cost. More important, two-thirds rejected concerns that it would spell the beginning of the end for the NHS and, furthermore, that it was against NHS principles. How will the private sector play a greater role in the future? We have witnessed a clear growing willingness to use private-sector providers alongside public provision where they meet the necessary quality and cost criteria. Competition and choice are good for the patient. On the funding side, there is a strong belief that the UK will inevitably have to consider options which promote public and private funding in tandem. These systems would have the triple benefit of increasing the total spend on health, lessening the strain on the public purse and urging a greater sense of responsibility by consumers towards their own healthcare. Health services should not be an either/or system where there is the choice of private medical insurance or the NHS. There should be a mixed healthcare econ- omy that combines public entitlement with private or voluntary funding. It is about giving more people more choice. In Australia six years ago, 35 per cent of the population had some form of private cover and the government was grappling with a rapidly growing healthcare budget. The authorities decided to bring on board the private sector and introduce a range of measures urging people to take greater responsibility towards their own healthcare. Now, over 50 per cent of Australians have some form of private cover and, most significantly, Australian state spending on healthcare has remained relatively flat. As we look at the future of health funding, it is important to consider the wider agenda and not just that of acute elective treatment. We will all have to work longer and those who work beyond today’s retirement age will need to remain healthier for longer. The inescapable fact is that this will put an even bigger burden on employers and corporate Britain, so the products and services we develop have to be more than just traditional private medical insurance and health protection. They have to help employers manage a whole range of issues relating to health and the productivity of the workforce, including sickness absence, rehabilitation, occupational health and stress counselling. The reality is that the cost of healthcare will continue to rise and all the extra money that has been invested in the NHS may not fully deliver. To tackle this, the answer may lie in the private and public sectors developing a system that affords even greater private involvement in the delivery of healthcare in the UK. What is needed is more debate. Then we can set our sights on how we can build a better health system for the people of this country, combining the best of the public and private sectors together.
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