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Guardian Live | How do we pay for the NHS we want – as it happened Guardian Live | How do we pay for the NHS we want – as it happened
(6 days later)
8.34pm GMT8.34pm GMT
20:3420:34
And that’s all folks. A show of hands reveals that a majority of those in the room work in the NHS.And that’s all folks. A show of hands reveals that a majority of those in the room work in the NHS.
Certainly, there’s no shortage of passion if the questions and comment from those here are anything to go by.Certainly, there’s no shortage of passion if the questions and comment from those here are anything to go by.
8.29pm GMT8.29pm GMT
20:2920:29
Smallwood says that the trouble with marketisation is that it drives quality down as the cheapest provider will always be the one which is chosen.Smallwood says that the trouble with marketisation is that it drives quality down as the cheapest provider will always be the one which is chosen.
The answer, he adds, is better planning. We need to move away from the myriad of small commissioning groups.The answer, he adds, is better planning. We need to move away from the myriad of small commissioning groups.
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8.27pm GMT8.27pm GMT
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Anita Charlesworth says that the future boils down to getting the right people with the right skills working together.Anita Charlesworth says that the future boils down to getting the right people with the right skills working together.
She adds: “We love playing with the structures. We absolutely adore it, but it’s a people based service and it’s having those people of the right skills working together that will be fundamentally important in terms of ensuring stability and sustainability.”She adds: “We love playing with the structures. We absolutely adore it, but it’s a people based service and it’s having those people of the right skills working together that will be fundamentally important in terms of ensuring stability and sustainability.”
8.26pm GMT8.26pm GMT
20:2620:26
Stephen Dorrell addresses marketisation, saying that he remains of the view that “intelligent commissioning” is part of the way to address how services are funded.Stephen Dorrell addresses marketisation, saying that he remains of the view that “intelligent commissioning” is part of the way to address how services are funded.
“Commissioning that moves away from lawyers and focused on different options for the delivery of services and making more intelligent choices about the way that services are delivered seems to be the way to go.”“Commissioning that moves away from lawyers and focused on different options for the delivery of services and making more intelligent choices about the way that services are delivered seems to be the way to go.”
8.22pm GMT8.22pm GMT
20:2220:22
Another audience member wants the “marketisation” of the NHS to be halted.Another audience member wants the “marketisation” of the NHS to be halted.
She is backed up by another audience member who calls for the reversing of privatisation.She is backed up by another audience member who calls for the reversing of privatisation.
“We are also on the verge, sadly, of a full-scale NHS insurance system,” he adds.“We are also on the verge, sadly, of a full-scale NHS insurance system,” he adds.
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at 8.23pm GMTat 8.23pm GMT
8.21pm GMT8.21pm GMT
20:2120:21
In a very unequal society, says Toynbee, the major challenge is about how to get one group of people to care more deeply about another group.In a very unequal society, says Toynbee, the major challenge is about how to get one group of people to care more deeply about another group.
“It might not be them today, but it might be them in the future,” she adds.“It might not be them today, but it might be them in the future,” she adds.
8.19pm GMT8.19pm GMT
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Dorrell says that the “killer question” was about the division of health budgets and the difference between social care and health care.Dorrell says that the “killer question” was about the division of health budgets and the difference between social care and health care.
The answer is, if you are an elderly person dependent on services supporting you at home, you are not remotely interested in whether it comes from the social care centre, the social housing department or from primary care, he says.The answer is, if you are an elderly person dependent on services supporting you at home, you are not remotely interested in whether it comes from the social care centre, the social housing department or from primary care, he says.
What is important is that you are benefitting from expenditure that will enable you to live a healthier and longer life.What is important is that you are benefitting from expenditure that will enable you to live a healthier and longer life.
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8.17pm GMT8.17pm GMT
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The way we compartmentalise public health budgets at the moment is a problem, replies Stephen Dorrell.The way we compartmentalise public health budgets at the moment is a problem, replies Stephen Dorrell.
He advocates joining up place-based budgets so you can invest in them.He advocates joining up place-based budgets so you can invest in them.
“How can you invest in paediatric budgets without involving the schools?”“How can you invest in paediatric budgets without involving the schools?”
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at 8.21pm GMTat 8.21pm GMT
8.15pm GMT8.15pm GMT
20:1520:15
Some more questions. An issue which has not been dealt with is how to manage the health budget at the moment, says a man who says he was surprised that he could buy drugs overseas a lot cheaper than he could at home - provided he had the correct prescriptions.Some more questions. An issue which has not been dealt with is how to manage the health budget at the moment, says a man who says he was surprised that he could buy drugs overseas a lot cheaper than he could at home - provided he had the correct prescriptions.
A woman says we are emotional about the NHS in a way that we are not about social care. What can we do?A woman says we are emotional about the NHS in a way that we are not about social care. What can we do?
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8.13pm GMT8.13pm GMT
20:1320:13
PFI got hospitals built but it was a total disaster, replies Smallwood.PFI got hospitals built but it was a total disaster, replies Smallwood.
“What is inexplicable to anyone who knows anything about economics is why does the government borrow money for next to nothing, because interest rates are so low, and build what is needed,” he says.“What is inexplicable to anyone who knows anything about economics is why does the government borrow money for next to nothing, because interest rates are so low, and build what is needed,” he says.
“Also, why don’t we renegotiate the PFI, I mean use some strong arm.”“Also, why don’t we renegotiate the PFI, I mean use some strong arm.”
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at 8.20pm GMTat 8.20pm GMT
8.08pm GMT8.08pm GMT
20:0820:08
Questions from the floor now. Tax evasion and tax avoidance is cited by one man, who suggests that everyone should pay similar rates, alongside a citizen’s wage.Questions from the floor now. Tax evasion and tax avoidance is cited by one man, who suggests that everyone should pay similar rates, alongside a citizen’s wage.
Another question is about the impact of PFIs on day to day hospital finances.Another question is about the impact of PFIs on day to day hospital finances.
The third one is about integration of health and social care. “Where do we decide that health and care are different?” asks a woman.The third one is about integration of health and social care. “Where do we decide that health and care are different?” asks a woman.
8.05pm GMT
20:05
Stephen Dorrell sketches out a future in which resources for health care could be raised locally, and also be linked up better across authorities.
“Does anyone seriously think it makes sense to have a primary care bureaucracy and a social care bureaucracy?” asks Dorrell.
The idea of linking local services is fine but it is going to take a very, very long time, says Smallwood.
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at 8.20pm GMT
7.56pm GMT
19:56
Anita Charlesworth says there is a real challenge. The OECD concluded in a major study that no one system was better than the other. Really, he says, it was about how they were run.
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at 8.48pm GMT
7.53pm GMT
19:53
Polly Toynbee says it’s true: money has to be found, and ultimately from people’s pockets. “You can call it insurance, but it’s still tax,” she says. “It’s still going to be an amount or another which households are going to have to pay.”
The reason, she says, why other countries have insurance-based systems is historic.
The German one, for example, is linked to trade unions.
“I think you have to present people with choices. I think there are other ways of raising money.”
Toynbee: hypothecated tax is one option for funding the NHS #ThisIsTheNHS
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at 8.13pm GMT
7.51pm GMT
19:51
Smallwood ventures the idea of “top-up” insurance. That might provide some of the extra revenue needed.
If not that, he asks, then what? He says he’s open to alternatives, but “ideology” shouldn’t be used to close down the argument.
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7.49pm GMT
19:49
“Insurance” klaxon. Nobody in the Guardian agrees with him on it, says Christopher Smallwood, but his concern is that the NHS does not have enough money, and as we go forward standards are going to erode.
Tax revenues are not being produced quickly enough to make up what is needed to meet financial pressures, “So the question is: where does that money come from? There is a problem that it should come from tax revenues and it should all remain free.”
The result? If we are going to be financing out of tax revenues, the increasing demands on health taxes will have to “rise and rise and rise”.
“I don’t think any political party is going to find that an appealing pitch to the electorate. Therefore, if we want to finance the health service properly, we have to be open-minded enough to think if there are other alternative ways of financing it.”
Just look across the Channel, he adds.
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at 7.51pm GMT
7.42pm GMT
19:42
Charlesworth is optimistic about the NHS in 10 years. The health system is not a broken model, she says, even if we spend a lot on the free-at-point-of-delivery model.
“Assuming that we get economic growth, then we should have enough to spend more on it if we choose to do so. The problem is how we get from here to there. That’s obviously a political challenge, and it’s dependent on all of us wanting to spend more and agreeing how to spend more.”
Findings from the British Social Attitudes Survey pointed to “rock solid” support for the NHS as a free-at-point-of-delivery model. However, most people also felt that the NHS wasted money, and this feeling was particularly strong among those who had more contact with the service.
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at 7.45pm GMT
7.39pm GMT
19:39
One of the challenges here is that doing the right thing for “health” might not be the same thing as doing the right thing for “healthcare”, says Anita Charlesworth.
Giving an example of what she says is a positive development, she says that the rate of teenage pregnancy has fallen. However, she links this to developments in education. “This has to be holistic. One of the things is that you get more plaudits from raising the healthcare budget, but you get rather fewer plaudits by raising other budgets that may help.”
Loneliness is going to be a major challenge in the years to come, she adds, but again, it may not be the healthcare budget that addresses it.
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at 7.43pm GMT
7.32pm GMT
19:32
We have inherited a commitment that the NHS should be tax-funded and free at the point of delivery, says Stephen Dorrell. Rather than promoting and sustaining the ability of people to lead healthy lives, this means that the service ends up being focused largely on treatment.
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at 7.35pm GMT
7.29pm GMT
19:29
The discussion moves on to international comparisons. A story we published today on that issue was the third most read piece on the Guardian site today.
Anita Charlesworth says that undoubtedly the NHS does very well in the measurements of the Commonwealth Fund.
However, we are bottom of the tables in terms of obesity and poor diet, which is a major driver of many of the poor outcomes, she adds. The OECD, she says, also notes that the NHS is quite a low spender.
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at 7.42pm GMT
7.26pm GMT
19:26
Stephen Dorrell says that what the CQC has been doing is to focus on a local health economy and the experience of care for those living in that community, rather than a “tick box” system of the past.