The National Institute of Economic and Social Research (NIESR) has put together some facts on the NHS: together they reveal a story that will probably surprise 99 per cent of the people in the UK.
The NHS is in crisis, right? Well, yes it is, NHS Trusts in England are in combined deficit to the tune of over £930 million. Many A&E departments in hospitals now routinely miss their 4-hour maximum wait target and there are record numbers of GP vacancies and many GP practices closing.
It’s in crisis because of chronic under funding, right? Well, that is kind of right and wrong.
It is wrong because spending on health per person in the UK has risen from three per cent of GDP in 1955, to 9.8 per cent in 2015.
Today, we spend an average of £2,160 per person on health care. NIESR says: “The evidence we have suggests that patient satisfaction with the NHS is higher than it has ever been”.
But, it ain’t enough. We are spending, more, but we need to spend much more. According to OECD figures, the UK spends less on health per person than Germany, France, Canada and a lot less than the US. In fact, spending in the US is close to double the UK rate.
And the reason why the NHS is in crisis is as obvious as the noses on the faces of its doctors and nurses. We have an ageing population, and as we age, we tend to make greater use of the NHS.
We are living longer, and the NHS is playing an important role in helping us to do this, but it comes with a cost.
NIESR says: “If we wish to see spending on the NHS rise we will need to increase taxes, or spend a higher fraction of public spending on health (at the expense of some other public service).”
So that’s the choice it presents: higher taxes or less spending on something else – and at a time when there is pressure on governments across the world to spend more on defence.
Alas, the UK public, egged on by most politicians, seem to want a third way, the have your cake and eat it way – a better NHS, that does not cost a penny in extra taxes canceled public services.
There is a fourth approach, one might refer to as the fairy-land option. NIESR put it more tactfully, but the inference is much the same, saying: “Alternatively if we wish to see the NHS remain, the same in terms of service delivery, we either need to make substantial efficiency gains, or consent to being charged for certain services.”
It said that the main political parties assume the former alternative is possible – so that is efficiency – and shrink from considering the second alternative – charging for services.
Looking further forward, there is a way that the efficiency gains can be secured, and this is with the combination of nano-sized sensors measuring our health, genome sequencing, big data and AI systems that compare data on each of us, with the big data they have access to. Such technology may reduce the need for highly paid GPs, and allow the possibility of experienced nurses, commanding lower salaries becoming our health advisors.
But the odds are good that as technology advances, our demand for health-related services will increase. Caring itself is one of the last jobs that will be taken on by robots – as the key characteristic of a good carer is empathy, and the day that robots can do that is the day that humanity might as well pack-up. But it is not hard to see how the availability of prosthetics, and the development of treatments for ailments that are currently considered untreatable, will lead to a need for even greater spending.
And whether that spending is carried out by the NHS or by users of health services directly, health care spending as a proportion of GDP will rise. But then again, is the price we pay for delaying ageing, for extending the average lifespan to 100, for making 80 year olds as fit as 50 year olds from a few decades back – is that not a price worth paying?
Truth is we have three options. Firstly, give up on trying to improve our health, and freeze spending on health at the current level. Secondly, throw money at the NHS and accept that government spending to GDP will rise, and tax to GDP will rise, or create some kind of privatisation of the NHS – our spending on health won’t reduce, but it will be paid via insurance premiums rather than via tax.
Any politician who presents the debate about the NHS in any other light, is lying.