Friday 26 February 2010

Hunter missed

Where is Hunter S. Thompson when you need him? It strikes me that with the world financial implosion of 2008, much of the authors' ranting about the triumph of greed-heads in America was vindicated.

An exponent of Freak Power he may have been - but just as the Fool in King Lear was the wisest of the bunch at court - so, it turns out, was Hunter.

A crying shame he was no longer with us and able to provide his inimitable commentary on events.

Monday 22 February 2010

Making £100m without the pain


In these cash-strapped times, it strikes me that there are opportunities for the NHS to make significant savings without threatening the 'free at the point of care' mantra at the core of our national institution.

The basic idea is to provide a basic level of cover, but provide 'upsell' where appropriate. Already expectant mothers can pay a fiver to take away a print-out of their foetal scans. The ability to book a private room (rather than a ward bed) should be extended and expanded. People who do not comply with doctor's advice should also expect limits on the free care they receive.

The results would not amount to a huge percentage of the health budget, but because the annual health budget is so vast - well over £100bn - a couple of percentage points still produces billions, not millions, of savings.

In particular, I believe there is an opportunity to conjure up £100m without disadvantaging those who can't or won't pay. How?

The scheme I propose is simply this: to pay £10 for the privilege of an appointment at a time of your choosing. Clinical outcomes would not be affected - this is all about fitting in with your lifestyle - it's about customer service - not about jumping the queue to get swifter medical attention.

How would it work? Right now NHS appointments are generally when they want them, not when you - the patient - wants them. All operations/appointments would be booked into slots within a given period. That period would vary depending on the urgency (or not) of the required treatment. So if you need something non-urgent seen to, that slot might be a week or a month long. Those that pay get the first choice of times within the first-available slot. Those that don't pay have to make do with the remaining appointment times, whenever they may fall within the same slot.

I stress that the point here is that clinical outcomes aren't affected. It's all about whether you get to go in at 9am on a Thursday - when it suits - compared with 3pm the day before, when it doesn't. Right now, no one really gets to choose very much so it's not greatly disadvantaging those that don't pay. However, it is providing benefit to those that do pay their tenner.

I haven't got hold of an up-to-date stat, but in 2005 it seems there were over 50m appointments scheduled by the NHS. If just 25% of these are booked at £10 each, that amounts to £125m a year. Even with transaction costs running at 20%, that still leaves the NHS budget £100m better off.