You could make a very good case for describing the small town of Tredegar, in south west Wales, as the birthplace of Britain’s National Health Service.
Situated on the banks of the Sirhowy River, economic historians rightly acknowledge Tredegar’s importance as a manufacturing centre of steel and an important coalmining town. However, as a municipality that suffered two cholera outbreaks at the peak of Britain’s industrial revolution, it’s not surprising that Tredegar also created an early template for the NHS.
Living conditions that accompanied relentless industrial progress throughout the nineteenth and early twentieth centuries were truly shocking.
Shoeless, underfed children dressed in rags endured overcrowding on a scale we cannot today imagine. Instances of families of seven, eight – and more people living and sleeping in the same room were commonplace. In larger cities, sanitary provision was negligible; infant mortality a heart-rending fact, the workplace a daunting possibility for many.
Little wonder that the Tredegar Medical Aid Society (TMAS), founded around 1890, is regarded as an embryonic NHS. It began life after a group of miners and steelworkers clubbed together to employ a doctor and an assistant, but gradually expanded to become something much more ambitious.
By the early part of the twentieth century, all local miners and steelworkers were paying threepence a week (in ‘old money’) into a central TMAS fund. Moreover, as other Tredegar residents were eligible to make contributions to the fund, nearly everyone in the town became a member. This eventually resulted in the Society employing half a dozen doctors and offering specialist hospital treatment where necessary. By 1924, the Tredegar-born politician, Aneurin Bevan, was elected to the Society’s hospital committee; it was here that he was directly exposed to the ‘embryonic NHS’s’ operations and procedures.
Almost two decades later, in June 1941, Sir William Beveridge was commissioned to produce a report on ‘Social Insurance and Allied Services’; the following year, his comprehensive plan for overhauling Britain’s social security system was published. It set out the concept of comprehensive public protection for all individuals ‘from cradle to the grave’ against sickness, poverty, unemployment, squalor and ignorance. This collection of ‘five evils’ were to be tackled by the provision of social services designed to improve public health and free medical assistance, supplemented by the establishment of state pensions, unemployment insurance, improved housing and public education.
Five years later, in July 1948, the NHS was born, guided by Bevan’s vision to ensure that basic medical attention was available to all. The organisation rapidly became a national treasure, a disciplined, well-run organisation envied the world over. And not a minute too soon. Children in particular were immediate beneficiaries: between 1948-49, more than 5 million pairs of ‘NHS glasses’ were issued to children. Once prohibitively expensive, their impact was startling. The same was true of the treatment of rickets, a condition caused by abject poverty. Within 20 years, this disease too had been virtually eradicated.
Fast forward almost 80 years and Bevan’s laudable vision for a body which has become the world’s fifth-largest employer is somewhat tarnished.
In many respects, the NHS has become too successful. Bevan’s vision was to create a larger version of the TMAS, a disciplined, sensibly run operation capable of treating the sick with basic medical attention available to all. During its initial five decades, this is precisely how the NHS developed.
However, as the UK’s population has exploded over the past two decades, we’ve grown depressingly used to hearing of phenomena such as ‘corridor care’, while arranging a doctor’s appointment requires an early morning visit to a burgeoning queue outside your local surgery and even then, there’s no guarantee an appointment will be arranged.
Many of us, including your correspondent, have benefited from NHS attention or care; for the most part, we have nothing but thanks for the medical staff who looked after us. Yet the organisation has morphed into a bureaucratic mess, alarmingly capable of swallowing colossal sums of money. According to the Kings Fund, last year’s NHS budget was £188.5 billion, almost half of which, £92.3 billion (that’s £3.26 billion a week), was spent on salaries, yet still patients wait in corridors, or face infernal waits for treatment.
Earlier this year, a close family member was told she faced a “150-week wait” to have her cataracts removed. The prospect of a three-year wait for surgery saddened her, for the only consequence of such a wait was increasing misery and a gradual deterioration in her eyesight. It was a horrible position to be in.
Ultimately, she and her husband raided their savings and paid a private clinic £6,400 to have her cataracts removed. The operation took place less than a fortnight after her first visit to the clinic. A month later, she was quite literally seeing the world in a new light. Now her husband believes his sight is also likely to deteriorate, though there’s little sign of the NHS waiting list shrinking. In perhaps 2-3 years, he fully expects to pay well over £7,000 to have his cataracts removed.
Commercially, it’s a similar story should people wish to rid themselves of longer-term pain and ‘go private’. Replacing a hip will cost around £12,500, while the cost of bilateral hip replacement will comfortably exceed £20,000.
Paying for a private clinic to replace a knee will set you back between £12,000 and £16,000 per knee.
If this sounds expensive, consider the cost of private residential or nursing care.
According to carehome.co.uk, the average weekly cost of private residential care is £1,298 (£67,496 pa). Nursing care costs an average of £1,535 (£79,820 pa), while dementia nursing care currently costs £1,564 a week, or £81,328 per annum. Frightening, isn’t it? Lord knows what Aneurin Bevan would say.
The state, meanwhile, has other calls on its – sorry, our – money.
Should an individual in need of care home attention own assets worth more than £23,250, then they are liable to pay the full cost of their care. Furthermore, when the value of an individual’s assets falls below £23,250 they must continue to contribute a proportion of their care home costs until they fall below £14,000. Even when the lower threshold is reached, individuals must contribute towards their care home costs from any income they receive.
These are significant sums of money – and not many people can put their hands on an eye-watering, five-figure sum at the drop of a hat.
Not surprisingly, therefore, millions of families worry about interminable delays for hospital treatment or, should they wish to take a short cut via the private sector, just how costly operations will be funded. Increasingly, families are spending time exploring the equity release option as a means of covering private clinic costs.
Equity release enables homeowners aged 55 and over to release a percentage of the equity built up in their homes, often over many years. Once released, the funds, which are tax-free, may be used for any purpose, including medical treatment.
Homeowners have the option of taking either a lump sum or using a ‘drawdown’ equity release plan to withdraw smaller, regular amounts, an arrangement that can prove convenient when medical and care costs are likely to be spread over a longer period.
Traditionally, there are no mandatory monthly payments to make for withdrawing equity: the funds only become repayable either when you die or move into full-time residential care, usually from the property sale proceeds.
However, equity release has evolved incredibly so over the past 5 years – with new options focusing on making repayments back to the lender in order to control the otherwise compounding debt. Voluntary payments of 10% are now mandated by the Equity Release Council on all lifetime mortgage plans – allowing upto 10% of the original balance to be repaid annually without any penalty.
Furthermore, a more recent innovation is the advent of interest servicing lifetime mortgages where an interest rate reduction is offered the more of the interest the borrower pays to the lender. Therefore, ‘choice’ has now developed into a providing a flexible lifetime mortgage standard within the industry.
Moreover, should one spouse need to go into full-time residential care while the other remains in the family home, the property’s value should not be included as an asset in a local authority’s means test calculation. This should result in reduced care costs, although it is dependent upon what other income and assets the couple may have.
Clearly, releasing equity is not for everyone and before plans are made to use equity release as a means of paying for any form of medical attention, it is important that homeowners take advice from a fully-qualified equity release adviser.
Meanwhile the UK’s population continues to boom and NHS waiting lists for treatment grow longer and longer as Aneurin Bevan’s vision, the inspiration for which was born in Tredegar almost 140 years ago, grows murkier and murkier.
