Claudia recklessly stares into the NHS’s dilapidated purse
Nearly 70 years ago when the NHS was established – principally as an urgent care service – the population of Britain was about 47 million. Life expectancy for men was 66 – it’s now 77, infant mortality was 24 per 1000 live births – now down to five, and there were three mass immunisation programmes – that figure is now more like 15.
Since then, starting with the rapid development of antibiotics from the 1940s, through to the advancing of scientific research, healthcare is almost beyond recognition today, as are the demands on the service that delivers it.
With more than half of people over 70 living with at least two long-term illnesses – and a quarter with at least three – it is no surprise that 70% of NHS spending now goes on managing that situation.
As a reflection of this, the NHS that operates today is not the same as the one set up in 1948 – numerous ‘top-down reorganisations’ have tinkered with it, or attempted wholesale change. Some fundamentals do, however, remain – the key one being the NHS’s system of funding.
A taxpayer-funded system, entirely free at the point of use, is a core NHS principal. Few in Britain argue that we need abandon this model entirely, but as with any complex infrastructure, there are no black and white choices, but a range of options within. While we know the NHS lacks funds, and that it has experienced these crises before, it is entirely possible that we have now reached a new low. Nine out of 10 Trusts are spending beyond their budgets, with an overall NHS funding gap of £20bn beckoning, by 2020.
Since most people have some awareness of the current NHS finances, it is astonishing that there hasn’t been a fundamental discussion about what the NHS should provide, what the public’s expectations are of free specialist treatment, and whether it’s ever going to be acceptable to charge for some services.
Indeed, whenever a known treatment or service is not made universally available – the new meningitis B vaccine for example, or various chemotherapy treatments, or GP appointments made at the whim of patients – some feel outrage without hesitation. Evidently the public do have an opinion.
Headlines in recent weeks lamenting the ‘rationing in the NHS’ and implying that it is something new, highlights the paucity of debate and lack of public awareness. Specific issues do trigger discussion from time to time, such as the recent survey by the British Dental Association, which revealed that 600,000 people a year seek a free GP appointment for toothache – costing the NHS at least £26 million a year.
Broadly speaking, however, consumers of NHS services come armed with a culturally inbuilt sense of entitlement with little regard to resource rationing. The latest headlines were triggered by a survey of doctors that found that seven out of 10 had witnessed restriction in approved NHS services and treatments in the past year, mostly for financial reasons.
Rationing of NHS services is not new and takes place across the board. From laboratory to hospital bedside, clinically effective new treatments are often denied entirely to NHS patients or – as this survey found – as a necessary ad hoc reaction to a budget deficit. This is precisely why NICE was set up in 1999 – to reduce variation in the availability of services – and why it continues to regularly make decisions based on cost, denying patients access to potentially worthwhile treatments.
Nostalgia tip: Claudia consigns sentiment to clinical waste
To be clear – no amount of efficiency savings or structural reorganisations will cut it – more money is needed if we want the same service, let alone an improving one. Or instead, let’s agree that we don’t. But headlines decrying the NHS for ‘forcing’ people to re-mortgage their homes to pay for expensive cancer treatment, while the same paper’s readership consistently refuses to accept any tax increases to fund these treatments, smacks of hypocrisy.
If we are so fiercely protective of our NHS, regularly topping as it does the list of things that make us most proud to be British, then why is it so politically risky to put forward the case that we all need to pay more for it?
And what of the NHS being the envy of the world? True perhaps, for the fondness its customers feel for it, but not in its service delivery or outcomes. Though there are metrics of which the NHS can be proud – our vaccines rates for example – we still fall behind in cancer, stroke and heart disease survival rates.
When researchers make scientific breakthroughs, unearth new technologies and unlock genetic secrets with the aim of developing long sought after cures, they want to see them benefit patients, and we want them for our families.
So, if you were that researcher, that scientist striving for the next big discovery, would you want your industry to engage with this wide debate? When your operation is delayed or your wife/husband refused treatment, do you want your political representatives to lead in helping us to understand why the NHS makes these decisions and consider what alternatives there may be?
The pharmaceutical industry should absolutely be doing all it can to reduce the prices it charges for medicines and increase the value they deliver. But should pharma also drive forward the message that the incredible improvement in healthcare that has transformed our lives – and in which it has played no small part – can continue at an ever-increasing rate, only if we are willing to pay more for it?
The discovery of new vaccines, diagnostics, medical technologies and medicines is in all of our interest. If we want GP surgeries to be open at all hours, hospitals to offer operations at weekends and equal access to the best medicines when we fall ill, we might even conclude that we are willing to handover more of our personal and national wealth to help the NHS deliver it.