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Saturday, 12 October, 2002, 09:14 GMT 10:14 UK
Parties square up over NHS
Pat Adams has chronic arthritis. Earlier this year, the 62-year-old from King's Lynn was told she would need one of her hips replaced.
Faced with a 15-month wait on the NHS and struggling to cope with excruciating pain, she re-mortgaged her house to pay the £8,000 cost of traveling to South Africa to have the operation.
She is one of an estimated 250,000 people who, disillusioned with the NHS, have dug into their own pockets this year to pay for essential medical treatment in the private sector.
Mrs Adams, like the vast majority of patients, has no ideological preconditions for improving the way healthcare is delivered across the UK. When it comes to having her second hip replaced in the months or years ahead, she simply wants to be treated quickly.
The government insists that its policies will ensure that this happens. Labour says its plans to boost spending, recruit thousands of extra doctors and to use spare capacity in the private sector will dramatically cut waiting times.
The Conservatives believe that encouraging people to take out medical insurance and partially reimbursing those who opt for treatment in private hospitals will also deliver results.
For the first time in many years, the two largest parties are offering patients what appears to be a clear choice on the future direction of the health service.
Labour believes the future lies in getting the NHS to make better use of the private sector. The Tories believe that the key is getting the private sector to take pressure off the NHS.
Mrs Adams has yet to be convinced that either set of proposals will deliver the improvements she wants.
"I know the government is spending lots of money on the NHS but I think its actually going to get worse. It really is terrible."
She is equally dismissive of Tory plans to re-introduce tax incentives to encourage people to take out medical insurance.
"I have had chronic arthritis since I was 28," says Mrs Adams. "I've looked into medical insurance in the past but with a chronic condition there's no way they will touch me."
Shadow Health Secretary Dr Liam Fox believes his policy will boost that number and help to reduce the "burden" on the NHS and "make way" for other patients.
The proposal marks a return to the policies of past Conservative administrations. Margaret Thatcher saw tax relief for people over the age of 60 who took out cover and for companies providing schemes to employees as a way of reducing demand on the NHS.
However, Labour disagreed and scrapped the incentives shortly after coming to power in 1997. Ministers said the policy provided poor value for money. Recent studies by the European Commission, the independent health think-tank The Kings Fund and the London School of Economics agree.
The insurance industry thinks differently. According to BUPA, the private sector carries out one in five of all non-emergency operations in the UK. It estimates that the cost to the government if those patients were treated on the NHS could be as high as £1bn annually.
Even if the value for money question is resolved, experts suggest the policy could create other difficulties.
"The problem with tax breaks is they tend to result in the private sector putting prices up," says health economist Dr Jonathon Shapiro.
A powerful private sector could also increase pressure on the already-overstretched health service.
"The real danger here is that the private sector will poach staff from the NHS," says Andy Bell of The King's Fund. "The NHS is no longer short of money but it is short of staff."
Mrs Adams is more supportive of the other Tory proposal - to contribute towards the cost of having an operation in a private hospital.
"But it has cost me a lot and because we've had to re-mortgage I do feel a bit under pressure now."
Under the Conservative plans, patients would receive money equal to 60% of the estimated cost of having the operation on the NHS.
Dr Fox said the policy, which is based on a system introduced in Finland, would give patients "a greater say about the care they have already paid for through their taxes".
The proposal could prove popular with patients. However, others may be harder to convince.
"It will only be of benefit to families on middle incomes," says Andy Bell. "The poorest people will not be able to benefit. It could also result in price inflation as the private sector increases fees in the knowledge that the NHS will foot the bill."
Doctors have yet to give their verdict on the Conservative proposals. The British Medical Association said it would give them "detailed consideration over the next few months" but added that it would only back the policies if they benefited patients and the NHS.
Some experts believe both parties need to go back to their respective drawing boards and to come up with more credible options.
"Politicians are failing to come up with radical reforms," says Andrew Haldenby of independent think tank Reform.
"Pilot schemes to allow the NHS to treat patients in the private sector or re-introducing tax relief for people who take out medical insurance are not going to catch the public's imagination. People are enormously dissatisfied with the NHS."
Mrs Adams would appear to agree. "The NHS was once the best in the world. When I was in South Africa they called it the Third World NHS. I don't think the situation is going to change. It is very sad."
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