· Features

NHS healthcare: change is afoot

With headlines like ‘NHS to lose 50,000 jobs’, many are wondering what next for UK healthcare.

Being the fourth largest employer in the world with 1.4million staff, it is serious, but in percentage terms, not as serious as the headlines shout. That said, there will be upheaval as changes take effect and both employers and employees are seeking greater healthcare certainty while innovative insurers create solutions to help supplement the NHS. Understanding the impact of these changes and what can be done to help their staff is going to be important for employers over the next 12 months.

Where the NHS has come from:

The NHS was formed in 1948 with the founding principle to provide a 'The National minimum [of healthcare]... No one is to fall below a certain standard, it leaves everyone free to spend his income above that standard as he will. It preserves the maximum of individual freedom and responsibility that is consistent with the abolition of want' (Beveridge 1948). Today, with unrelenting medical innovation, demand exceeds supply and the world cannot afford all of the healthcare that it aspires to.

Where the NHS is going:

The coalition Government's solution is reform; symptomatic of life in the NHS for the last 20 years. At 367 pages, the bill is larger than the one that formed the NHS over 60 years ago. It proposes an NHS run by an independent health board, GP consortia to do purchasing, a healthcare market open to 'any willing provider' and expanding the transparency and availability of health data. Nearly everyone agrees the need for change, it is just the extent and the timing that is open to debate.

Reading between the lines, there is a move towards care in the community (keeping patients out of expensive hospitals) and controlling costs without sacrificing quality. The accusation that the NHS is being privatised is a nugatory one bearing in mind that the private sector was intrinsically involved within two years of being launched. With ministers resigning in 1951 over dentistry and prescription charges, it remains as emotive today as it was then. The recent publication of a 'what we commission and what we don't' schedule by a west country health trust is similar to an insurer's benefit schedule; a back to the future basic 'National Minimum' level of healthcare that the founding principles referred to. As with all kinds of change, there is an initial period of disruption. The headlines are already predicting: rationing, malnutrition, 'bed-blocking', queues, MRSA and lack of care. As a result, there is an increasing demand for supplementary medical cover, be it health insurance or cash plans which top up NHS care.

One insurer who has 'declared' its hand in this direction is not-for-profit insurer, WPA, with the launch of NHS Top-Up last October. Some will recognize the dental, optical and therapy benefits as a cash plan where WPA's strategy has been to evolve the product away from that description because 97% of the UK do not know what a cash plan is; NHS Top-Up does 'what it says on the packet'.

NHS Top-Up has been described as an active 'employee assistance programme' (EAP) where the active benefits (dental, optical etc.) are complemented by the passive elements such as 24/7 helplines and face-to-face counselling. Employers can purchase it where premiums start at 92p per week or by employees at a discount negotiated by employers.

In line with the rest of Europe where the majority, 93% in Holland, supplement their healthcare more and more companies are considering their options; one company in Northern Ireland who has not given a pay rise for three years purchased NHS Top-Up because the annual £50 cost per employee was significantly outweighed by the perceived value.

Topping up the NHS will become the norm in the coming years in order that the UK can afford the healthcare that it aspires to. Preventing employees being ill and promoting healthy living both at home and in the workplace will follow through integrated health and productivity initiatives. We live in interesting times.

Charlie MacEwan, director at WPA