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The debate around healthcare in the UK is too often polarised between those who advocate for a US style system (private healthcare that is determined by the ability to pay, whether through insurance, income or state support) versus the UK model (the publicly funded NHS, free at the point of use).
Some argue for a hybrid of both, otherwise known as the ‘social-insurance model’ or the ‘Bismarck model’ (a health care system financed through compulsory, income-related contributions paid by employers and employees). However, regardless of the delivery system, the debate often misses a crucial aspect of healthcare which is rarely discussed, namely preventive medicine, which potentially has far-reaching consequences, both financial and personal.
Preventive medicine can proactively detect health issues before they become severe, significantly improving a patient’s future quality of life and extending lifespan. By shifting the focus from treating advanced illnesses to supporting wellness, this lowers medical costs, eases the burden on healthcare systems, and boosts societal productivity.
The current system at a glance
The National Health Service (NHS) is the UK’s publicly funded healthcare system. Founded with the core principle of being free at the point of use and based on need rather than ability to pay. It is one of few health-care systems in the world which is entirely free and funded directly by general taxation.
The NHS is organised horizontally. Administrative/commissioning bodies hold and allocate funds, while clinical care providers deliver the services. In primary care – the frontline of the NHS – this includes your local GPs (family doctors), dentists, community pharmacies, and opticians. Secondary care specialists deliver hospital care, which is typically accessed via a referral from a primary care provider. Lastly, there are integrated care systems (ICSs). In England, 42 local ICSs coordinate care. (These partnerships bring together NHS trusts, local councils, and charities to manage budgets and tailor care to the specific population’s needs.)
Change is on the government’s agenda
The new Labour Government has pledged an NHS overhaul, with Prime Minister Sir Keir Starmer stating that “this isn’t just going to be solved by more money, it’s solved by reform”. But the specific model has not yet been clarified. One notable think tank, the Institute of Economic Affairs, argued that the NHS should be replaced by a European-style social health insurance (SHI) system to boost the UK’s lagging healthcare outcomes (the UK consistently ranks lower in health outcomes – such as cancer survival compared to our European counterparts). In a recent report conducted by Lord Darzi, found the NHS to be in a ‘critical condition’. Moreover, Lord Darzi’s independent investigation concluded that the NHS is in ‘serious trouble’ with falling productivity, surging waiting lists, and a deteriorating state of the nation’s health. The report identified four major causes: a decade of austerity, the impact of the COVID-19 pandemic, absence of a patient and staff voice, and disruptive top-down reorganisation. I would like to suggest a policy proposal which I believe could transform the NHS and reverse its decline.
A Cuban style healthcare system incorporated into our NHS
The Cuban health system is a globally recognised, state-funded model built on hyper-local, preventive medicine and community primary care. It deploys neighbourhood family doctor-and-nurse teams to monitor the health of every citizen, shifting the focus from expensive hospital treatments to early, community-based interventions. Moreover, the system is highly decentralised and highly organised, allowing the island to achieve life expectancy and infant mortality rates much higher than comparable wealthy nations, despite suffering severe economic constraints such as embargoes and sanctions.
The three-tiered system can be explained as follows:
Tier 1: Community Clinics (Consultorios): the foundation of the system. A local family doctor and nurse oversee the health of about 150 to 300 families. They conduct morning check-ups and afternoon house visits to evaluate social, economic, and environmental factors affecting their patients’ health.
Tier 2: Polyclinics (Policlínicos): acting as community hospitals, these provide secondary care, emergency services, and host visiting specialists for the local consultorios.
Tier 3: Hospitals and Institutes: highly specialised tertiary care reserved for complex surgeries, cancer treatments, and advanced research.
How would this work in practical terms within the framework of our current NHS? Firstly, several community clinics (including GPs within them) would be set up in every council ward (parish or town councils) – covering no more than a population of say 10,000 people. These would collaborate with polyclinics. Subsequently, multiple polyclinics would be established in every council ward (district councils) to ensure that these serves no more than a population of say 50,000 people, who would then collaborate with hospitals. Finally, hospitals set up within a higher tier of local government (equivalent to county councils) would be managed by NHS Trusts*.
Incorporating a Cuban-style health system into our NHS, would still enable us to retain the key characteristic of the NHS; free treatment at the point of use, but this would allow us to massively improve clinical outcomes at a fraction of the cost to the British taxpayer when compared to a social-insurance model or a private health-care model. There are three areas that illustrate this.
Preventative focus over curative
Rather than waiting for patients to get sick, the Cuban-style health uses a preventative model: neighbourhood-based family doctors and nurses live in the communities they serve, allowing them to closely check individual health, environmental factors, and early warning signs of illness. In other words, the aim is to stop people getting ill in the first place rather than treating them afterwards.
Curative medicine implies making therapies available to a patient with the aim of fully resolving the problem and bringing her or him back to the health status they enjoyed previously. Preventive medicine also includes actions that guard against disease occurrence – actions targeted at eliminating or suppressing the impact of disease, or if not possible, slowing down the advancement of disease. A universal example of preventive medicine that can be seen today is the promotion of vaccination, to reduce the spread of an infectious virus, such as COVID-19.
Universal and free access
Access to healthcare in Cuba is enshrined as a constitutional right. This goes further than in the UK. All care—from routine checkups and complex surgeries to dental care and medication—is provided free of charge. A similar service here would allow us to retain a key pillar of the NHS, namely healthcare free at the point of use, without compromising the integrity of the NHS as a whole. Retaining such a pillar reduces the stigma low take-up associated with means-testing and builds broad public support for such an essential service, establishing an egalitarian baseline of dignity for everyone.
Exceptional Health Statistics
Some relatively poor countries’ health indicators rival or exceed those of much wealthier nations. Cuba has achieved a life expectancy averaging around 77-81 years and the country’s infant mortality rates are among the lowest in the Americas, typically, around 4 to 5 deaths per 1,000 live births, which is comparable to European countries like the Netherlands.
Integrating such a system into the NHS is another reason to make this change, given our current exceptionally low clinical outcomes, given our expenditure per head.
I believe my proposal for the NHS deserves consideration. Moving further towards private intervention is not the answer. Encouraging people to take a more active interest in their health by working with neighbourhood practitioners close at hand is the answer. Improved preventive care has the potential to extend everyone’s healthy life while saving the NHS significant amounts by not having to deal with problems that have been averted.
* Primary Care services would also be expanded to 7 days a week. ↩︎
Kayed Al-Haddad is spokesperson for The Liberal Party for Economics, Fiscal Policy and Monetary Policy.
