Since its inception in a post-war United Kingdom, the National Health Service has demonstrated that it is possible to care for all, without cost at the point of access
By Kawaldip Sehmi, CEO, International Alliance of Patients’ Organizations
In 1948, Britain’s health minister Aneurin Bevan, made the bold move to set up the National Health Service in a war-ruined and nearly bankrupt United Kingdom. In doing so, he appreciated the value of universal health coverage for society, viewing it as an investment and not a cost. Today the NHS is a much-loved national institution that has helped shape the United Kingdom’s economic, social and cultural life over seven decades.
In a most prophetic moment, Bevan had said that in his new NHS, “if a patient bedpan is dropped in a hospital corridor in Tredegar, the reverberations should echo around Whitehall, London”. Indeed, health became a political choice for every generation in the United Kingdom.
The patient and carer voice and perspective have considerable influence on the country’s politics. Elections in the United Kingdom are now won and lost on the basis of which political party’s manifesto promises greater investment in the NHS. Waiting lists at hospitals can translate into voter lists during elections.
Globally, patient advocates want health ministers gathering for the United Nations High Level Meeting on Universal Health Coverage in September 2019 to learn from Bevan’s example. Patients want their health ministers to make the bold decision to invest in universal health coverage in their own countries. The United Nations has appreciated that the third Sustainable Development Goal, on health, will have an impact on every other SDG.
The World Health Organization has been right to push for health in all policies. The NHS was a major driving force behind the post-war United Kingdom’s economic development. It has in fact ‘hot housed’ the entire industry involved in innovative health technologies and innovative medicines via various satellite company spin-offs and collaborative centres.
Patients want to ensure that each UN member promotes, respects and protects patient participation and involvement within the universal healthcare institutional framework, which spans law, policy, and practice and standards. Today many ‘expert-patients’, who because of the chronic nature of their diseases, have navigated most of their healthcare pathways, advocate that the patient voice and perspective must be the firm foundation upon which universal health coverage is established globally.
For our health finance to produce the best value for money, patient-centric universal health coverage must be the cornerstone of all healthcare systems. Learning from other consumer-focused industries, where consumers are encouraged to participate in and contribute towards the development of the products and services, our universal health coverage must be shaped by the patients and their communities. Other industries know that this participation not only improves the consumer experience of their products and services, but also improves the safety, quality, efficiency and effectiveness of the industry – this affects the bottom line.
Another expectation from the High Level Meeting was adequately expressed by Global Action on Patient Safety, the report by the WHO director-general and the resolution adopted by the WHO Executive Board in January 2019. As universal health coverage covers more people, offers new services and reduces the out-of-pocket expenditure for many, the benefits of increased access to health care may be undermined by service structures, culture and behaviour that inadvertently harm patients and may lead to fatal consequences.
Patients want safe and good-quality universal health coverage that will reassure them and their communities that they can trust healthcare systems to keep them and their families safe.
Bevan and other healthcare policymakers in the 1950s did not face the current healthcare landscape, with its fast-changing health systems and a workforce operating in increasingly complex environments. Rapidly evolving treatments, technologies and care models, despite improving clinical effectiveness and efficiency, can in themselves become a threat to safe health care.
Patient safety is now becoming a big and growing global public health challenge. Countries, while improving access to health care, must also encourage expert-patient participation and engagement to assure that in planning and resourcing their vision of universal health coverage, they are not presiding over flawed and wasteful models of care.
Lastly, we must not forget that medicine retains its societal roots, no matter how complex its structures. Patients want to see universal health coverage that positively encourages compassion in health care. Health ministers must humanise health care and ensure that staff, vulnerable patients, families and communities are well supported and that their participation and welfare become the other cornerstone of patient-centric universal health coverage.