The aims of the NHS
Overall, in relation to prescription charges, in a period where the NHS is being pushed to its limits, free prescriptions for all would be difficult to maintain in the long-term and healthcare professionals in primary research expressed their agreement with this view. Prescription charges bring around £500m per year for the NHS, despite 90% of us not paying in England. If prescription charges were abolished, where would this money come from? The taxpayer would have to fund the NHS charges further, and so this would lead to a similar situation. Critically, it is unreasonable that over-the-counter medicines can be prescribed, and so the role of the government inmaking items such as paracetamol unavailable over prescription in England is a positive step forward. However, one must wonder as to why the government did not act sooner, in particular in Scotland where paracetamol is still available as a free prescription. Dentistry Since 1951, dental treatment has been subject to charges, against Aim III. This raises serious questions, as to whether people will seek care when they need it. Figures suggest that 50% of people pay for their treatment and the rest are either children or non-paying adults. 57 Welch claims ‘the NHS has betrayed its founding principles’ 58 and suggests that this policy has cut off many patients. The British Dental Association has called this ‘a tax on teeth’ 59 and has taken the view that charges have exacerbated health inequalities among society. The report 60 claims that GPs are being inundated with 600,000 patients with dental problems and even A&E being faced with 135,000. Arguably, this phenomenon could be viewed as a vehicle of increasing the pressure upon other healthcare professionals, and therefore not fulfilling Aim II. An initiative that was created to raise funds and reduce demand has, ironically, achieved the complete opposite. Data suggests that the state funding component of NHS dental services is on the decline and, in connection with the section on Funding, makes us question the role of the government. Can the government be seen as fulfilling Aim III, if their input is on the decline and they are relying more on people to pay? Thus, this leads to the development of inequality, highlighted by 26% of Bangladeshi people, often a community with high levels of poverty, in London having never attended a dental appointment. O the other hand, it may seem unfeasible to provide universally free dental treatment for patients. Criteria are supposed to be in place to address this issue, e.g. with those on income support, to make sure they receive care. Dental units, within a hospital, are available for urgent cases, but this again shifts the burden to other healthcare professionals. Missed appointments are a great cause of concern for dentists and it would be pleasing to see a shift in approach from the government to allow them to impose fines on patients, rather than exclusion from a practice, tominimize a wasteful attitude of services and resources. In this way, this will allow dentists to increase efficiency and see a greater number of patients, and the money generated could help fund a means- tested system. One must acknowledge that this is a very controversial issue and there are several recommendations given. Primary research suggests that a universally free system would not be favoured and fundamentally the greater cost would make this unsustainable. A system that looks at someone’s background would be more favoured and as a result helps to alleviate the inequality. It is often people from lower socio-economic backgrounds who bear the brunt of the current policy and therefore, this
57 Welch, 2018. 58 Welch, 2018.
59 British Dental Association. 60 British Dental Association.
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