You do not need me to paint too much of a picture when it comes to the strains on our beloved NHS service. We hear much about funding and staff shortages in all areas and that’s we are trying to do more and more with for an increasingly ageing population with less of a real term funding allowance. However, how much of this is actually true? And more importantly, has the NHS reached the point of no return?
One of the most telling issues with our health service provision is waiting times. Recent findings by the Royal College of Surgeons found that people waiting longer than 18 weeks is at a 10 year high. GP surgery waiting times are at an all-time high and the average wait for a non-urgent appointment now nearly 17 days and 52% of people asked were unsatisfied with the GP services in the UK. Waiting times were at the forefront of the reasons for people’s dissatisfaction with the service.
So why the increased demand? Along with increasing demands to see GPs, the complexity of patients’ problems has also increased. A 10-year study of more than 15,000 people in England, aged over 50, showed a 10% rise in the number of patients who have two or more long-term conditions, so-called “multimorbidity”. NHS England has suggested that this is currently the greatest challenge facing the NHS, a challenge largely being managed by GPs. Patients who live longer, but with more health problems, also face the potential problem of polypharmacy, the use of multiple medications, sometimes justifiably, sometimes not. A 15-year study of over 300,000 patients in Scotland showed a doubling in the number of individuals who were taking five or more medicines. Avoiding the harms that medicines can cause, while maintaining their potential benefits by optimising their use, is a challenge faced by every GP every day, and one that can rarely be managed during a typical 10-minute consultation.
So based on this it seems that it is not so much the increased life expectancy of the population, or indeed the funding challenges in the system but the decreased health of our population that provides the most challenging quandary? If the NHS service is to survive and indeed improve, it is going to take more than money to fix the problem. Funding, whilst cut in some areas has grown significantly over the last two decades.
The Brown/Blair axis committed massive increases in funding to the NHS. Between 1997 and 2008, health expenditure in cash terms more than doubled from £55.1 billion to £125.4 billion. Expenditure on health care per capita increased from £231 in 1980 to £1,168 in 2000, and by 2008, it was £1,852. However, since 2010 although funding has increased its real terms value has more than halved and its clearly taking its toll. Funding in 2009/10 was £112billion and was 124.7billion in 2017/18/
As a service, the NHS is actually relatively efficient despite public perception. Compared to other industrialised nation’s healthcare systems we operate a high level of efficiency and productivity. That said it also well noted that more waste could be eliminated and as a service fully funded by the taxpayer its only right that continued efforts take place to find savings wherever possible. The UKs NHS has long been touted as the best health service in the world and the envy of other countries. Despite this, no other country has ever mirrored our exact model and in terms of the things that matter to the patient i.e. access to medicine and waiting times it seems clear that its shortcomings a clear for all to see.
More worryingly for me is how we perform in terms of the key health metric – actual health outcomes. When it comes to overall outcomes the NHS ranks very poorly on a global scale. So how do NHS health outcomes compare with those of health systems from around the world? In a report by Dr Kristian Niemietz compiles OECD, Lancet and Eurocare data on survival rates of cancers, strokes and other measures of the health system of each country. The report shows that the UK falls consistently far below other countries for survival rates and is far from having the best health outcomes in the world. If we had the survival rates of those countries with the best health outcomes, over 46,400 lives a year would be saved.
So is more funding the answer? Various numbers of additional funding requirements have been bandied around by various political parties and key figures in and around the health service its self but will there ever be an optimum amount of money flowed into one of the largest organisations in the world? We know funding slowing down in real terms; we know it is not as much as other countries spend on healthcare. However, as its sole funded by the taxpayer could it ever be enough? The NHS in my view was an absolute necessity when it was founded. Born out of a need for more social parity when it came to health. But even its founder new it had its limits. Nye Bevan said back in 1947 it would never be enough, he also said that it needed to be used responsibly. Two things that aren’t much talked about these days in the political arena. For me the ageing population isn’t the issue, the funding isn’t the issue and even the complexity of patient healthcare isn’t the main issue. There is no main issue. There are hundreds if not thousands of issues; Leadership style, workforce motivation, GP Pensions caps, locum wages bills, never-ending bureaucracy, internal and external waste, unnecessary replication of management structures, lack of centralised purchasing for key items, unrealistic expectations of patients and political game playing to name but a few. So in terms of the key question in this blog, where is the NHS now and is there any way back? I think the health service still does a great job in certain aspects of its mandate and I think improvements can still be made.
But I also think people need to stop holding it up as a shining beacon of social justice and health fairness and start using it in the way it was designed. The government on both sides of the isle also need to stop using it as a political football to scare the populous into voting of them. Most importantly, we need to accept that things change and systems need to adapt. A free at the point of entry service was always going to run into difficulty, particularly one that was funded from day one, an entire generation of people who never contributed financial to the system got healthcare available straight away. We have in essence been playing fiscal catch up ever since. My biggest plea would be the 50 million people in the UK who use the NHS annually, please take care of yourself, responsibility and self-ownership are free so let’s have some more of that.
Ben Paglia is the founder and CEO of AKEA LIFE a Private GP Service working with families, businesses and sports clubs across the UK.
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