Finding the balance to keep the NHS thriving


Written by Editorial Team

Published October 2019

In this article...

The National Health Service turned 70 last year. Founded by Health Secretary Aneurin Bevan in 1948, it was stated at the time that “the collective principle asserts that no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means”.

It’s an incredible service, offering access to world-class treatment for free at the point of access. Yet fast forward 71 years and the NHS is in a perilous place. As of 31 March 2019, *19 trusts were in special measures – with 10 of those because of their financial circumstances. While this puts further scrutiny on trusts to make significant reductions in costs, it potentially misses a different avenue to explore – one that balances the time and resource that are dedicated on cost savings, with ways to increase revenue.

The NHS is an organisation like no other. It experiences almost continual change and has many challenges to address, including rising demand and heightened expectations at a time when resources are constrained. To achieve the change required and deliver real improvements, new and sometimes untried ways of doing things should be explored. For example, the NHS is, and will always be, a service designed primarily to be free at the point of care. However, there are circumstances where payments are necessary and appropriate, and failing to secure these revenues is a source of loss to the trust that can be avoided.

This doesn’t mean a radical overhaul of all the charges the NHS could make, but a different mode of thinking – one that looks at the missed opportunities for generating income that works in tandem with the efficiency savings that trusts are required to deliver on a daily basis. Within the NHS long term plan, investment in and making better use of data and digital technology is one of the five key areas they are looking to deliver on.

Imagine, for example, providing the ability to take contactless payments when out-of-hours prescriptions are dispensed. When you consider the time and administrative costs involved in pursuing payment of invoices that carry a high risk of not being settled, suddenly prescription charges can easily be settled at the point of delivery service. It may seem a small step when you consider the wide adoption contactless payments already has, but the NHS has much to gain from riding the crest of new payment models to seek income they’re entitled to for paid-for services.

Payment service providers can supply a smart mobile payment solution, where a device connects to a trust’s mobile phone or tablet via the app, to seamlessly take payments for out-of-hours A&E prescriptions. Let’s look at an example of a trust dispensing 63 prescriptions per night. At today’s charge of £9 that trust could potentially generate £567 of additional revenue every night - over a year that equates to over £206,388.00 worth of revenue, an amount that trusts may be currently struggling to recoup.

And it’s not just mobile payments that can have a big impact on revenue streams for the NHS. The UK is one of the most enthusiastic markets for online and mobile purchases**, so it makes sense to ensure that fees for medical services, facility charges or even smaller fees such as parking payments can all be paid online. To provide the best possible user journey when setting up an online payment facility, it’s important to remember how many people may wish to pay using a smartphone or tablet, and to ensure web pages are mobile-friendly.

Take the example of a patient visiting the hospital for a pregnancy scan, where payments could be taken at the time of taking the ultrasound pictures. This then avoids the patient needing to traipse around the hospital to make payment at the cashier’s office, before taking the receipt back to the clinic to collect their scans.

Offering a variety of payment methods may help to recoup some of the ‘lost’ money the NHS is owed from non-eligible patients. The NHS has issued guidance for taking payments from non-eligible patients but there is some way to go – 23 NHS hospitals across the UK are owed more than £1million from foreign patients and 91 trusts have outstanding bills totalling £149.5million***.

We’ve come to expect choice in all areas of life, and especially in how we choose to pay for products and services. We tend to take quick, convenient payment methods for granted, whether it’s online, in person using Chip & PIN and contactless, or via the telephone.

With the shift in culture towards smartphone use, and the payments arena continually evolving, the opportunity time is ripe for the NHS to be able to improve the patient pathway experience and to make the most of consumer habits to maximise the income opportunities available to them.

If the NHS is to have sustain, improve and transform thrive for another 70 years and beyond, continuing to offer free treatment to qualifying patients at the point of delivery whatever their circumstances, trusts need to balance their focus not only on reducing costs, but also on securing the revenues they’re due.

*FoI request via The Daily Mail -
** - Global Online Retail Spending – Statistics and Trends
***NHS Trust Development Authority: annual report and accounts 2018/19 -

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