Moral hazard in the NHS- Medical Matters with Derry GP Dr Tom Black

Providing a free health service creates a situation where people alter their behaviour because it is free and this results in an inefficient service. This is a form of moral hazard and we need to guard against such behaviour. Other examples are patients who start statin medication to reduce their cholesterol often increase their fat intake in their food and one patient thanked me for curing his stomach ulcer and explained that he was now able to smoke and drink without any problems as a result of his new medication.

Patients in the Republic of Ireland go to their doctor less frequently and are healthier and live longer. If you have a severe illness in the UK you can qualify for additional payment which you lose when your health improves. One man with severe angina deteriorated and he needed a quadruple heart bypass but then lost his DLA as he was better. He was better but he was very unhappy. We need an NHS that encourages patients to be self reliant and not to be dependent, passive recipients of state largesse.

We are now in a very difficult situation in the UK where we can no longer afford the type of NHS we used to receive. It’s difficult to get a GP appointment, an ambulance, an outpatient appointment or an operation and some waiting lists are now 5 to 10 years long.

How do we maintain a free NHS which protects the vulnerable in society while at the same time making it efficient and effective enough to encourage taxpayers to pay for it.

Many people think that we need charges so that patients think twice before accessing prescriptions and services. However, you need to be very careful with this because even co-payments where you only pay a part of the cost results in decreased use by vulnerable patients. What we’re doing now in the NHS is rationing with waiting lists forcing people who can afford to go private. The advantage of some patients paying privately is that this frees up spaces in the NHS for other patients but it creates health inequalities where the poor and elderly have worse health.

The other way society is managing this health crisis is simply not to have a service for certain conditions and mental health services are suffering as a result. I used to be the person who argued for a universal, free at the point of need NHS but I have no confidence that this will ever return so we need to think differently.

If the politicians actually sat down with something like a citizens assembly and decided what the NHS will provide and what it won’t provide and then assured the public of a high-quality accessible service for children, elderly, cancer, maternity services and emergencies we would be in a safer place.

Pretending to provide a universal free service when it isn’t even available is the worst possible service at present.