Guest blogger

If we stand back now, the NHS may tip over the edge of its own ‘fiscal cliff’. Future health care services face serious challenges such as changing demographics (particularly ageing), increasing obesity levels and rising costs of new treatments and medicine.

To do nothing about the increasing demands being placed upon the system would be a political mistake.

I believe that the current infrastructure, and the widespread and relatively unchallenged acceptance of a service funded solely by the taxpayer, will lead to poorer patient outcomes than we should be achieving.

We have no choice but to fundamentally change the way this country’s health care is funded and delivered in the 21st century. As a politician and a medical professional, I am constantly battling with the challenges facing the NHS. There is a real need for consolidation of hospital acute services, to release funds which can help to improve the quality and performance of community care.

We have to make some tough decisions about future funding now, to ensure that the chronic and terminally ill patients of the future have the care that they need

Furthermore, I strongly believe and have argued on several occasions that health care costs, driven upwards by the inexorable increase in patient demand, have now reached a tipping point.

Any politician who thinks that the current NHS financing model and physical structure can be sustained in the medium to longer term is deluding themself. By doing so, they are exacerbating the trust problem that all politicians currently have with an increasingly cynical public.

It is time that politicians told the truth about the NHS: that the reality of health care provision in Britain today has changed, and will change even further over the coming decade. It is time to engage in an informed debate with the British public and then take the required action to save our universal health care service before it is too late.

As a GP, I have seen over 50,000 patients, and I am struck by the stark differences in behaviour developing between the generations. The stoic attitude of the post-war generation is significantly different from that of people born more recently. Behaviour has an impact on the conditions I deal with: when baby boomers hit their eighties after 2025, around 25 per cent of the NHS budget will already be spent on diabetes alone.

Without doubt, an increasing number of people in future will be getting prescription medication for conditions related to lifestyle choices. According to the NHS, over 886 million prescriptions were dispensed in England in 2009 at a cost of over £8.5 billion, a figure that is set to increase.

This is why we have to make some tough decisions about future funding now, to ensure that the chronic and terminally ill patients of the future have the care that they need.

As the 22 per cent of the British population born between 1945 and 1960 start drawing their pensions over the next few years, there is a real danger that the resulting costs will exclude younger generations from access to an NHS free at the point of use.

For our health service to be efficient and effective during these economically challenging times, responsibility for health care funding should be moving slowly away from the state towards the individual.

We also need to restructure our acute health care services, which will require district general hospital closures, consolidation of acute specialist services into larger, new ‘hub’ hospitals, and the building of new community clinics.

Changing the public’s mindset on these issues will be extremely painful politically, with no short-term reward – but we have no choice if we are to protect the fundamental principle of access for all. I want people to be free to choose any lifestyle they wish, while understanding its future health care cost implications.

I want to give more to the truly deserving because we have spent less on those who were perfectly able to provide for themselves. I want the very best 21st-century health care to be delivered in safe and appropriate environments.

If we do not persuade the public of the need for these changes, it is the truly vulnerable in our society who will be placed at risk.

Dr Phillip Lee MP is the Conservative Member of Parliament for Bracknell, and a GP in the Thames Valley Region. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.

To read further reflections from parliamentarians on the recent NHS reforms, download a joint report from the Nuffield Trust and The King’s Fund: The view from Westminster: Parliamentarians on the future of health and social care (June 2013).

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Comments (4)


In 1976, as an 11 year old, I was diagnosed with type 1 diabetes. The treatment was with bovine insulin injected using a glass syringe and re-usable needles (hardly the best way to persuade a young boy to self-inject, to make him use needles that rapidly go blunt). Monitoring of my control was via urine tests, with a test tube and caustic tablets that fizzed and changed the liquid a colour between green and red (sadly, I saw red more than I saw green). I was told by the consultant that by the time I was 50 I would need a kidney transplant, or dialysis. The consultant was justified in saying this. At that time treatment for diabetes had changed very little since insulin had been discovered in the 1920s and the the diabetics he knew, who had had diabetes as teenagers, had had failing kidneys by the time they were 50. Insulin then was costly, as were transplants and dialysis.

I am 48 and I have just had one of my regular blood tests for kidney function. My kidneys are working fine. I will not need a kidney transplant when I am 50. Because of GM technology, Insulin is cheap, it is also far more effective than the insulin I was taking when the consultant had made his prediction. The drugs I take to protect my kidneys (ACE inhibitors) are also cheap, and the costs of transplants and dialysis have dropped. In other words, over the last 40 years the health of diabetics have improved, and the cost of treating them has dropped. No fiscal ckliff there. Indeed, there has been a nice gently downward sloping plain, and it is likely to continue like that.

Like that consultant you are making predictions about the future without knowing what the future will hold. I will go further. My consultant was clinically justified to say what he did, and it was good that he was wrong. But you are not justified and you are blinded by vile politics. This is shown by the statement you make: "responsibility for health care funding should be moving slowly away from the state towards the individual". There is no clinical reason for this, it is purely political and a form of politics that most people rightly revile. You gripe about "conditions related to lifestyle choices". Well, fine, that is a public health issue and the solution is to put more money into public health, so you should be stopping your colleagues in DCLG from trying to raid the public health budget for housing and roads. Are you?

Co-pay is a tax on the sick and those people who advocate co-pay do so for political, not clinical reasons and I do hope voters recognise that such people are not worthy to represent them.

Richard Grimes
25 June 2013

One way to lower the cost of healthcare would be to pay GPs less money. Strangely Dr Lee does not advocate this.
Another way would be if the State exerted more control over NHS procurement via centralisation using economies of scale. Strangely Dr Lee does not advocate this.
Dr Lee talks about the concept of "deserving" recipients of care. This clearly splits us all into deserving and undeserving groups. Strangely Dr Lee does not explain how the undeserving will be cared for.
I struggle to understand how such a distinction is consistent with how a physician should conduct themself. Clearly it is a struggle to be both a rightwing Tory and a caring and non judgemental practising GP. Having worked with many people from other countries where the onus is put on the individual to care for themselves, I'm proud that we have the NHS and embrarassed to have Dr Lee as my MP holding the opinions he does.

Alistair Samuelson
09 August 2013

The evidence does not seem to support Dr Lee's views - moving to patient paying actually means Dr Lee advocates "no health care for the poor" - it cannot mean anything else. The evidence is clear - the US spends more money on health care, the suoer rich get brilliant results, but along the way key indicators like life expectancy and infant mortality for most people are far worse - whilst a fortune is wasted on lawyers and accounts to administers contracts and insurance claims.

One way to cut costs dramatically would be to nationalize GP services as GP Partners earn much more than employed GPs.

The attack on the NHS and the other institutions of the 1945 revolution by the Conservatives is a traitorous betrayal of everything the first two generations of the 20th century fought for.

Richard Coe
21 August 2013

Dr Lee is the current Tory MP for our constituency in Bracknell, so we feel a duty to rebut some of the dangerous nonsense that he preaches. Our substantive reply to his article is here:

22 August 2013

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