Sally Warren answers your questions!

Warren, Sally photo.jpg

Hi, my name is Sally Warren and I’m the Director of Policy at The King’s Fund. The King’s Fund is a charity that works to improve health and social care. We carry out research into what is working and what could be better in the NHS, public health and social care.


With UK/US trade talks occurring and the NHS being rumoured to be part of it, can we trust the outcome will be good?
cheerful_photograph, The Sherwood School

This was a hot topic in the recent election cheerful_photograph.

What makes the NHS the NHS is that it’s free at the point of use, based on clinical need not your ability to pay. That won’t change regardless of the outcome of trade negotiations with the US, or any other country.

Other countries might want to negotiate so that they can supply key products or services for the NHS, like medicines. It’s important to remember that the NHS already works with lots of companies from around the world to help it run every day - from the food patients eat in hospitals, to pharmaceutical companies who make medicine, to technology like computers and bits of equipment like x-ray machines. And the NHS has processes to make sure when it buys things from companies, they are safe and that it gets good value for money, so taxpayers don’t pay more than they should.

Whatever the outcome of trade deals, what won’t change is that the NHS will remain a universal health care service - free for you to use if you or your family need it.


Do you think we have the best health service in the world?
buzzing_duck, John Ray Junior School

That’s a good question buzzing_duck. And the answer depends on what you mean by ‘best’? What is most important to you?

Some international studies do rank health care services in the UK as the ‘best in the world.’ The Commonwealth Fund compares health care across some of the richest countries in the world and ranks the UK first overall - based on five areas. But that hides that the UK is very good on some of the five things - like equity (or fairness) - but much less good on some of the other things, like health outcomes (these are changes in health that result from specific interventions like preventing death after a heart attack through in-hospital care).

Some other studies of health care in European countries have the UK more in the middle of the pack of wealthier countries.

So the real answer to your question buzzing_duck, is that nobody really knows!

I think the fact that the NHS is free at the point of use, and therefore is available to everyone who needs it is a real strength of the NHS. But the NHS isn’t the best at everything - there are things it needs to do better.


How do you think NHS will change in the future and what will be the impacts of that change?
warmhearted_wolverine, Upton Cross Primary School A

Health care services always change as new treatments for diseases are discovered. This has been true for decades (well centuries really!).

Let’s just think back over the last few years. We now have new treatment for cancers which means more and more people survive to live a long life after a cancer diagnosis. We now have an HPV vaccine which prevents the virus which causes cervical cancer – so fewer and fewer women will get that disease.

As well as advances that improve our chances of survival by better treatment, we also see conditions which seem to have become more common – more people have Type 2 diabetes now as a consequence of obesity, and more people have dementia as more people live longer lives.

These kind of changes are happening all the time as scientists make new discoveries, and they will continue to happen in the future. They have an impact on the type of services the NHS needs to provide.

But as well as changes to diseases and medicine, we will also see changes in how the NHS uses technology to deliver services. I’m guessing, warmhearted_wolervine, that you can use technology a lot of school and at home – messaging your friends, playing on line games, and doing your homework. So why shouldn’t the NHS use technology better too? In a few years, you might not need to go to the GP surgery or the hospital to see your Doctor or Nurse. You could do it through your phone. That should make it more convenient for you - no more having to miss a whole morning of school for a hospital appointment!


In a few years, you might not need to go to the GP surgery or the hospital to see your Doctor or Nurse. You could do it through your phone.

Sally Warren


Do you think we will always have the NHS? And if not, will we have to pay for our health care in different ways?
sceptical_imagination, Ormiston Six Villages Academy

That’s a great question sceptical_imagination. I’ll give you my very short answer – we will always have the NHS? Yes.

Why do I say that with such certainty? Time after time in polls and surveys the British public say that the NHS is the thing that they are most proud of. Given that the public hold the NHS to be that important, it’s hard to think that they could also vote for a political party who said they wanted to abolish the NHS. And I think if any Government tried to do that, there would be a lot of opposition in Parliament, and across the country, and it wouldn’t happen.

But if my answer to your first question had been no, we might not always have the NHS, what are the other ways of paying for healthcare? There aren’t all that many. The NHS is a type of social insurance – we all pay in through tax and national insurance (people who earn more money pay in a higher amount) and its available to everyone who needs it.

The alternatives to this are private healthcare insurance and pay as you go.

Private health care is where you choose whether you want to buy insurance - that means you pay a set amount (a premium) every month and in return get health care should you need it. This is the system that the US has. There are lots of reasons why this isn’t as fair as the NHS – firstly, not everyone can afford the premium every month, so not everyone will be able to get insurance. And secondly, health care insurers can refuse to give you insurance if for example you have family history of certain illnesses. So that means that people might not have the option to buy insurance.

Pay as you go means that you save up money to be able to pay for health care when you need it - that’s probably okay if you are talking about a trip to the GP which may only be a few hundred pounds, but if you needed to pay from your own money for an operation, that might be more than you can afford, so you might go without the medical help you need.


Time after time in polls and surveys the British public say that the NHS is the thing that they are most proud of. Given that the public hold the NHS to be that important, it’s hard to think that they could also vote for a political party who said they wanted to abolish the NHS.

Sally Warren


Do you think the British public take the NHS for granted and if we do, should it become privatised?

believable_cricket, Bruncliffe Academy

That’s a really good question believable_cricket, and there are a few different parts of my answer!

Do we take the NHS for granted? The NHS normally tops the polls of the thing that British people are most proud of. So my first answer would be no, we don’t take it for granted because we know it’s something special that we feel pride in.

But it’s a bit more complicated than that. Because the NHS is free when we use it, we don’t really have sense of how much it costs for that GP appointment, or when we needed to go to A&E. That can sometimes mean we can take it for granted and not use it as well as we could do. For example, if we knew how much it cost, we might go to ask our Pharmacist for advice first rather than having a GP appointment – and that would be cheaper for the NHS and probably a bit easier for you and your family too given school and work. So in that regard, we do take it a bit for granted - we expect it to be there when and wherever we need it.

So if we do take it for granted, should the NHS be privatised? What do you mean by privatised, believable_cricket? I ask because a lot of time when people talk about privatising, they think the NHS is one big public sector ‘thing’. But that’s not true, there are already lots of private businesses that work as part of the NHS. For example, your GP is a private business who provides the NHS with a service through a contract. They are not employed by the NHS, they are private businesses, and yet they provide more than 300 million appointments every year for NHS patients. But nobody thinks of our GP service as privatised. So we already have quite a mix of different types of organisations delivering health care - some are in the public sector, others are businesses. But its all free when we need to use it. I don’t think changing that balance will change whether we take the NHS for granted or not.


What a great set of answers from Sally Warren! There's certainly lots to think about in them.

  • Is there anything that surprised you? Why?
  • What do you think the most important answer was? Why?

Give your answers in the comments below!

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