Tim Pauling, Press and Journal, 10 April 2009
A legally binding charter should be introduced setting out the care and treatment which patients can expect from the NHS, according to a Scottish think-tank.
Reform Scotland said the charter, or NHS Constitution, would make the system more answerable to patients and put an end to “postcode” treatment.
It believes the NHS should become more like “insurance-based” systems found in other European countries.
The charter is among a series of “radical” recommendations set out in a report, Patient Power, which is underpinned by the idea of more choice for patients and greater competition between healthcare providers.
Think-tank director Geoff Mawdsley said the charter goes further than provisions in the Scottish Government’s Patients Rights Bill as it defines entitlement to care, as happens in Holland.
According to the report the NHS is not providing value for money. Despite a 55% increase in spending in the last 10 years, Scotland still lags behind comparable European countries.
The report says health services in countries such as Sweden and the Netherlands, whether funded by the public purse or insurance-based, are designed with incentives to meet the needs of patients.
It calls for health boards to be replaced with new co-operatives solely responsible for commissioning treatment from separate providers.
Hospitals would be run by independent non-profit making trusts.
Reform Scotland wants to scrap performance-related targets. Mr Mawdsley said while these had resulted in shorter waiting times, they will eventually “hit the buffers” and a new system will be needed to bring about improved patient services.
Supplementary insurance would allow patients access to treatment and drugs not provided on the NHS, without penalty.
Mr Mawdsley, one of the report’s authors, said the NHS in Scotland has many strong points, in particular the fundamental principle that everyone should be guaranteed access to healthcare – and that should remain its cornerstone.
Other countries have enshrined that “vital principle” without the need for a public sector monopoly over healthcare.
Mr Mawdsley said while there have been improvements, the health system is not working as well as it should, and not because of a lack of money.
He said: “Top-down performance management of a public sector monopoly is the root of the problem. We need reforms which put patients first and enable the system to develop according to their needs and wishes.
“The best way to achieve this is to introduce elements of patient choice and greater competition between healthcare providers into the system. These are the keys to increasing productivity, to providing real value for the money invested in our health service, and to raising standards for all.”
Liberal Democrat health spokesman Ross Finnie said: “This report is nothing more than a playbook on how to privatise the NHS in Scotland. It calls for patients to be given a right to opt out of the NHS and top up healthcare with insurance payments if they can afford to do so.
“This will lead to a two-tier system that will be ultimately detrimental to patient care.”