The NHS And Its Future

06/12/2016 12:04

American author P J O'Rourke once said: "if the NHS is brilliant, wonderful and a national treasure, why is every [political] party promising to fix it?"

The point that O'Rourke misses is that the National Health Service is deeply ingrained into our culture, and does not (always) take kindly to criticism and some political leaders have even threatened to 'weaponize' it (whatever that means.

But we are living longer, rates are up from 71 years in 1960 to over 80 now, more diseases are curable, and the NHS now takes almost £120 billion of the total tax revenues per year and employs 1,400,000 people.

However, looking at the NHS in isolation does not give us anywhere near the full picture. Just this month the Organisation for Economic Co-Operation and Development published its annual assessment of healthcare in Europe, "Healthcare at a Glance: Europe 2016," and its finding are worthy of note:

• The UK has the ninth highest per capita rate of expenditure on healthcare, with €3,084 being spent per year versus an average of €2,721. Germany spends €4,083, France €3,342, and Italy €2,476.
• The UK spends 9.8% of its GDP on healthcare, the eighth highest.
• The UK is thirteenth highest in its per capita pharmaceutical spending (€361 versus EU average of €402).

So it appears that, given the United Kingdom is second/third largest economy in Europe, in relative terms the NHS is underfunded. A closer look at the OECD numbers reveals that:

• The UK has only 2.8 doctors per 1,000 population, almost bottom of the heap coming in at number 25. Greece tops the list with 6.3 per thousand, Germany has 4.1, Italy 3.9, and France 3.8.
• We fare slightly better when it comes to nurses, but still mid-table; we have 8.2 practising nurses per 1,000 head of population (11th highest). Denmark tops the list with 16.5, Germany has 13.1, France 9.6, and Italy 6.1.

If that was not bad enough only Sweden, Ireland, and Denmark have fewer hospital beds per head of population.

But it is all very well to point out the problems, but what is the solution. Just throwing more money at it will not suffice, nor will tweaking it by (say) stopping 'unnecessary cosmetic' treatments or charging for missed appointments. Some savings could also be made by better education for our youngsters, getting them to eat more healthily (actually despite Jamie Oliver's protests our kids do not fare too badly in comparisons with obesity or smoking, although the OECD do highlight the excessive consumption of alcohol among the under 18s).

We have alarming levels of cocaine and ecstasy use, almost the highest in Europe, and this is a problem that requires more efforts with the education and police services. We also have almost Europe's highest HIV and Sexually Transmitted disease rates, expensive to treat but easy to prevent.

We could cut out the number of well-paid bureaucrats, the Taxpayers Alliance concluded that in 2015 534 members of NHS quangos and an additional 2,381 employees in non-clinical roles were paid over £100,000 per year.

We could attempt efficiency savings: recently the Academy of Medical Royal Colleges highlighted potential annual savings of £2bn through better use of medicine, tests, operating theatres, and hospital beds.

Perhaps more generic drug usage could save more than its estimated £12 billion per year.

Talking as someone who has spent my life's career in healthcare, what I do know is this: we face tough choices for the NHS. Do we rip it down and start again, or do we make do and face the obvious consequences of higher taxes for everyone? Those are the realities for the NHS, and it is about time that the politicians make clear to us all how they stand on this, and make plans for healthcare in the UK for the next fifty years, not just until the next election.