Category Archives: #Healthcare

“The biggest disease of them all is the growing income inequality”

Eeva Mielonen examines consequences of income inequality to healthcare.

The Future of Healthcare in Europe conference, jointly organised by the Finnish Institute and UCL on May 13, discussed current issues in healthcare provision. I am interested in the future of public services in general, and I was surprised how thought-provoking and inspiring many of the contributions at the conference were.

Two weeks afterwards, I’m still reflecting on Professor Sir Michael Marmot’s speech about the importance of fair policy-making. For him the word ‘fair’ is not just a quick cover-up for bad policies. He suggested that the word is used too easily nowadays, in a way that in fact makes a mockery of its true meaning. He pointed out that there should be more reflection on the policies drafted and their consequences.

Marmot spoke very convincingly on behalf of a fairer society. He said that, if we want a healthier society, we have to understand that a healthy way of living requires a minimum wage that makes healthy choices possible. In a way that sounds very ‘Nordic’ to my ears. He even spoke of the unfair taxation in the UK: “At the moment people on the top end of the earning scale are paying 35% in tax, on the other end of the scale, the poorest people pay 38% in tax. Is this fair?”” More progressive taxation could be one of the instruments for funding a more equitable and efficient healthcare system.

The nature of the problems in healthcare seems to be more political, social and economic than medical, and so are the remedies. Applying stronger progressive taxation and openly discussing the cuts in public services, instead of concealing them, could well be part of the solution.

In Finland the problem in healthcare provision seems to be poor access. In the UK, in comparison, access to healthcare is good, and as Marmot said, this is a major societal achievement. But in both countries inequality in healthcare is a growing problem. Government social and economic policies have an impact on the overall health of the people. 

I quite often find that in Finland we want to believe that it is still 1988 and that we live in a welfare state with a broad set of measures preventing the polarisation of society. In fact, we are moving at increasing speed towards a harsher society, where economic differences are accompanied by social problems, and where good health is a luxury for those who can afford it. At the conference it also became evident that the Finnish healthcare system needs reform. Questions that should be asked include: Who is healthcare for? How can we fund it? What are the consequences of having a weak healthcare system?

We are at the crossroads and we had better not take the wrong turning: Or we could end up living in an unequal society where the money in your pocket dictates the state of your health. Based on the conference we might already live in this kind of society. 

Eeva Mielonen
The Finnish Institute in London

Liberating the NHS or repeating the mistakes of the past?

Eeva Mielonen is blogging about liberating the NHS.

Out of curiosity I went to hear what the Labour leader Ed Miliband had to say about the by now infamous NHS reforms. The impressive RSA lecture hall was packed with people – and journalists, as RSA Chief Executive Matthew Taylor wittily pointed out. Every day now there seems to be someone publicly opposing the reforms, and finally the whole reorganization is now on ice after a group of senior MPs applied the brake. 

At the core of the reforms is a shift of responsibility away from various administrative bodies inside the NHS to England’s 35,000 GPs, who will take charge of the £105bn budget. According to Health Secretary Andrew Lansley, the mastermind behind the reforms, GPs recognise the needs of patients best. The costs of NHS bureaucracy will be cut by a third. All these radical actions are to be accompanied by the establishment of an independent NHS Board to allocate resources and offer commissioning guidance. The reforms also address issues of democracy. Patients will have more say in the care they receive, for this purpose HealthWatch will gather feedback from patients and monitor NHS performance. So, while some of the bureaucracy is being demolished, a set of new bodies will start working.

According to Miliband, the ideologically driven reforms have been put forward hastily and could have a negative long-term impact that could endanger the entire UK healthcare system. Miliband was keen to demonstrate that Labour is not against changes as such and that introducing methods such as payment-by-result during the 1990´s has produced a better NHS. Miliband also discussed the impact of the increasing role of the private sector in healthcare provision. As he pointed out healthcare is a very different service from, for example, energy. Miliband also asked how accountability will be enforced on private companies delivering services.

I agree with Ed Miliband on many of the points he made. The NHS must be reformed in a way that not only realizes one man’s vision, but also enjoys wider acceptance. I also find it worrying that so many GPs seem to be opposed to the reforms and to their new commissioning role. That there is greater need for collaboration between GPs and hospitals goes without saying, so it seems odd that increasing competition between hospitals is supposed to lead to better co-operation between them.

The NHS has a special value for Britons. In a country where there has been extensive privatisation of public services in the last 20 years, the NHS could be described as the only thing that is left of all the progressive social reforms that Beveridge envisaged in the post-war period. No matter how much we appreciate public healthcare, the ugly truth is that demographically our societies are developing in a frightening direction, where there seem to be more and more old people needing care and less young people to provide them with this valuable care.

Many studies have shown that reforms aimed at greater efficiency and less bureaucracy in the public services have sometimes led to quite undesirable outcomes, such as increasing bureaucracy. We all seem to agree that something must be done. But the way that Lansley and the government are acting echoes the mistakes of past.

Eeva Mielonen
The Finnish Institute in London
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