It is early 2020. We have missed the A&E target for 4 years. A&E waits make headlines, and some predict being charged massively overpriced sums for drugs as Trump claims rights to the NHS as the price of a trade deal. And privatisation is apparently the secret agenda anyway. But what are the facts, the trends and the history? Here is the first of three blogs based on my career which included being an A&E Consultant from 1989 until 2017, on the theme that the NHS is chronically underfunded courtesy of both parties.
I started as a medical student in 1973, and have watched the trials and tribulations of the NHS over these past 47 years. And to remind you, that meant a patchwork of political paymasters, 18 years under Labour and 27 under the Conservatives +/- Alliance, namely:
1974 Labour, 1979 Conservative, 1997 Labour, 2010 Conservative / Liberal Democrat alliance, 2015 and 2019 Conservative.
The Organisation for Economic Co-operation and Development is an intergovernmental economic organisation with 36 member countries, founded in 1961 to stimulate economic progress and world trade. A recent OECD report shows that right now, the UK has the second lowest number of beds and doctors in Europe (the lowest is Poland) compared with its population. Britain has 2.8 doctors per 1,000 people, compared with an OECD average of 3.5 doctors. Bed numbers are also among the lowest, with 2.5 per 100,000 people, compared with an OECD average of 4.7. Why? Can we blame the any one party? I think it is more nuanced than that. Maybe we need to understand our history.
Just before the NHS started in July 1948 NHS, its author, Aneurin Bevan spoke of the medical profession’s worries about the service, and said if there were problems they could easily be put right. That month, the Editor of the British Medical Journal, while seeing the logic of spreading the high cost of illness over the whole of the community, also saw dangers in a state medical service, with lack of incentive, massive administrative costs, stereotyped procedure and lack of intellectual freedom. Additional resources were negligible, and the appointed day brought no extra doctors or nurses. Within weeks Bevan was reputed to have become worried about the burgeoning costs, fearing its un-affordability.
NHS funding has been a problem from its inception. Funding as a % of GDP languished between 3 and 4% from 1948 to 1976, ensuring all building and equipment stock slowly deteriorated, and guaranteeing large renovation and repair bills for the future. Around the year 2000, under Tony Blair funding as a % of GDP had reached 5%. At that time the government introduced out-sourcing, meaning that for the first time contracts could go to non-NHS providers. This has since been pejoratively referred to as ‘NHS-privatisation’. But it may have eased funding pressures as costs could be reduced. Funding reached 6% by 2005. Meanwhile, other nations had outstripped the UK. The last few years have seen an increase, and we now register 7.5%. The interesting fact is that if the % of GDP spending on the NHS is plotted by year, it is very difficult to identify which political party was in power at any given time. The fact is that no political party has a record to be proud of, though none admit to that.
So where are we now? By all key metrics, the UK is the second worst in the 10 major world economies shown in this table. I have omitted the USA which has the highest spending and the lowest life expectancy as it is (and always has been) a very inefficient system.
|Country||Spending per person ($)||Gov spend as %GDP||Total spend as %GDP||Life expect at birth|
Government spending as a % of GDP is an honest measure of affordability, and a good measure of how we value healthcare, a bit like defence or education spending. But each country adds to this with private healthcare funding. In the case of the UK, this adds 1.5%, Norway adds 2.5% and Switzerland over 4.5%. As UK spending, governmental or total, is below average, it follows that more spending or private healthcare may be needed.
But here are some interesting things: healthcare spending does not correlate with life expectancy, and people in Italy live the longest, despite being bottom of the league! And pressure on emergency care is widespread across Europe, with long waits in the Republic of Ireland and France, our two closest neighbours. So what should we do? Follow Johnnies Blog for the next installment!