2. The NHS – The money flow. How funding affects the way you receive care
Welcome to Self Care! Today, we set off on our quest to gain as much relevant health knowledge as we can with the aim of improving our health and happiness.
(Matt – Founder of Health Control with over 20-years’ experience in the health sector)
My name is Matt, and I will be the narrator for Self Care, sharing my knowledge, but importantly gaining input from Clinicians, Health Experts and NHS Specialists along the way. Treat this blog as part 2 of a 12-part agenda – Part 1 was simply the introduction. You can review previous Self Care blogs any time by clicking HERE.
The aim of our topic for today is to understand the money flow through our NHS, to gain an insight into why the care we receive is provided in the way we receive it. We want to have a base knowledge of how our NHS works for us so that in future Self Care blogs we can discuss how we can navigate and benefit from it better. We’ll also introduce you to the NHS Long Term Plan so you can start to see what the future NHS may look like.
How the NHS is funded – where does the money come from?
Fundamentally, we all pay for our NHS services in three ways:
- From general taxation.
- From our National Insurance Contributions (NIC).
- From Patient Charges such as prescription fees and dental treatments.
Each year the Government goes through a process called the Spending Review. It is designed to help the Government estimate how much income the NHS will receive from the three sources above. If NIC or Patient Charges are estimated to be lower than expected, then the Tax factor is used to make up any deficit.
Can Hospitals generate their own money?
Individual health care organisations, like a hospital (for example), can also generate their own income on top of what it receives from the Government. This is why you’ll often be charged parking fees and see private wards at NHS hospitals. You will find that most NHS organisations will have a business focused team or individual who will try to develop their organisation to run more like a business. In a hospital you will have various Business Manager roles and in your local GP surgery you will now have a Practice Manager.
Consider the Boss!
If you think about how a hospital is managed, a Chief Executive will have overall responsibility. Their objective is to provide a safe, efficient, and forward-thinking hospital estate. They will receive a budget to work with – and if the hospital is not effective, they will have to raise funds in other ways.
Therefore, the overall leader of a hospital and their Executive Team play a huge part in creating the overall standards you receive as a patient or visitor. We may wince at the price of paying for a car park in a hospital – it could be that price because the hospital is being run inefficiently, or it could be that price because the hospital is funding innovative, life-changing practices – usually it is somewhere in-between.
It is always interesting to google who is running your local hospital. A great example is the current (March 2021) Chief Executive of the Western Sussex Hospitals Trust, Dame Marianne Griffiths. Read Dame Griffiths’ short profile by clicking HERE.
As with any company you are thinking of doing business with, knowing the perspective of the leader helps you make a more informed decision – so consider that when you consider your health. You can now choose where you are treated, so if you have future treatment planned, do some research, and help yourself feel more confident about the facility you will use and the people that run it.
The United Kingdom is a group of four countries, each with its own Government accountable health organisation: In England we have NHS England. In Scotland there is NHS Scotland. In Wales there is NHS Wales and guess what, in Northern Ireland, there is…Health and Social Care! Even though they nearly all share the same name format, they act in different ways.
For example, NHS Scotland was the first of our nations to really succeed with implementing what is called integrated care – an aim to have seamless care between secondary (e.g., hospitals) and primary (e.g., community services) settings. The new NHS Long Term Plan by NHS England is very much focused on this integrated care approach. Have a listen to this short overview of the NHS Long Term Plan by clicking HERE.
So, your respective NHS organisation will be provided with a budget. They will then cascade this budget down, splitting it between primary and secondary care. As it costs much more to treat people in a hospital environment, the focus will be on creating more improved services to manage your ailments in the community, outside of a hospital or specialist care centre.
Have you noticed the changes? – The NHS Long Term Plan
In England, you may have really noticed the effect of the NHS Long Term Plan coming into play. Have you been recommended to chat to a local pharmacist recently instead of going to your GP? Have you been assigned an appointment with a community disease specialist instead of a hospital consultant? What is happening is that a GP’s time is being freed up to help keep you out of hospital. They now have improved community services so that they can refer you to a community specialist rather than the expensive hospital.
The COPD example
Let’s take an example. Chronic Obstructive Pulmonary Disease (COPD) used to be a disease that we all thought was simply down to smoking. However, now COPD is a class term for a range of respiratory illnesses including emphysema, bronchitis, and bronchiectasis. In the past, if you had COPD you would most likely, at an early stage, be referred to a Consultant in a local hospital. They would then ask you to attend a frequent clinic held at the hospital. This was costly and inefficient. Patients with chronic COPD can struggle to get to the kitchen, never mind the 3rd floor of a hospital two bus rides away, managed by an expensive Respiratory Consultant, every second Thursday of every month. The drive to bring respiratory services closer to a patient’s home means we now see:
- COPD clinics in GP surgeries run by Nurses.
- COPD clinics in local chemists run by Pharmacists.
- Teams of Specialist Respiratory Clinicians based in GP surgeries or community clinics.
The hospital is still there for you, but it has dropped down the pecking order. Does this mean the new community systems will be perfect? It will take time for this integrated care to become efficient, but it should deliver improvements and allow the chronically unwell to be treated at or near their homes more often. We’ll have to be a little patient.
Finding Local Support
So, the budgets are being split with increasing weighting being added to community services (primary care). You can find out about health care provision in your area via the NHS website. If you want to find out more about local services in England, our suggestion is this:
- Visit the NHS website (https://www.nhs.uk/).
- Use the ‘Health A to Z’ and look up that specific disease.
- For most diseases, you’ll find a link saying something like ‘Find your Local XXXX service.’
- Follow that link and type in your own postcode.
- You’ll then see a list of local services available to you.
- Contact them – give them a call and see what they can do for you, you might be surprised.
For Wales, Scotland and Northern Ireland, the format is slightly different, but the same rule applies. Take a look at your local services from the main website and then contact them to see what they can do to support you better:
NHS Scotland has the excellent ‘NHS Inform’: https://www.nhsinform.scot/
NHS Wales has ‘Health in Wales’: https://www.wales.nhs.uk/
Health and Social Care for Northern Ireland has ‘Online’: http://online.hscni.net/
Hopefully, you’ve picked up some nuggets of information here today. You are now aware of the NHS Long Term Plan for England. You know that Scotland leads the way with integrated care. You know how the Government raises the money for our health care and the process it goes through to split it out. And you know that community care is the future. So, why not test your knowledge? Here are five questions you should now be able to answer. You’ll find the answers on the next blog.
- What is the job title of the overall Leader of a Hospital?
- What is an example of a Secondary Care facility?
- Name one disease that can be classed as COPD?
- What is the health care plan for NHS England called?
- Name the three ways in which the NHS is funded?
Join us in two weeks’ time for the next Self Care education blog: ‘The NHS – The structure and how this affects you and how you are cared for.’ We’ll dive deeper into the structure of our care system so we can understand the links between the various care settings, that we’ll all be visiting one day!
Finally, for those of you in England, you can access the NHS Long Term Plan by clicking HERE.
Founder of Health Control