The future of the NHS is uncertain. Healthcare in the UK faces some grim realities; shrinking budgets, rising expectations and an aging population. An expert panel was brought together as part of this year’s Festival of Economics to discuss how long the NHS has left to live. The panel, chaired by Hugh Pym (BBC), included Adriana Castelli (University of York), Kath Checkland (University of Manchester), Paul Johnson (Institute for Fiscal Studies) and Carol Propper (Imperial College London/University of Bristol).
The first area for debate was funding the NHS, with a practising GP explaining the urgent need to increase spending on the NHS to cover costs. There is popular consent for taxation to save the NHS, which Kath Checkland felt could be fixed with around 10% of GDP. She noted that since 2010 the NHS budget has only been increased by 1% each year, much lower than inflation. A pay freeze since 2010 has saved £800m, but GP income is now below that of 2004, with nurse income down 6% since 2010. Kath felt that as of 2015, there has been no more fat to trim, and the NHS can only be saved by an increase in spending. On this issue, the panel were all agreed. The only way to rescue the NHS from certain death is to spend our way out of trouble.
Variation between trusts due to staffing was another area of significant concern. Carol Propper pointed out that one of the biggest challenges for the NHS was variation. She pointed out that the difference in staff performance between the best hospitals and the worst was 50%. The key driver of this variation, according to Propper, was staff motivation.The workloads of GPs, for example, have risen by 16% since 2010, with more consultations and increasingly complex patient needs. As pay freezes and conditions worsen, it’s harder to attract quality staff. She argued that the overseas staffing crisis is the largest problem the NHS will face, as 1 in 5 nurses and 30% of doctors come from outside the UK. In 2016, 1500 nurses applied to work in the UK from the EU, yet by 2017 this number had reduced to 46. Propper continued to explain that although the willingness to fund the NHS through taxation is there, without proper staffing the NHS is doomed to fail.
Adriana Castelli felt that the future of the NHS lay instead in its productivity, and specifically with the effectiveness of management. As the population ages, more patients with complex chronic conditions are using the service, which she pointed out was not its original intention for the NHS. Without effective management, trusts could not expect to remain productive, even with an increase in spending. Even if productivity grew at the rate of inflation, Castelli believed that by 2020 we would still need an extra £6.6billion to rescue the NHS. However, with current management performance, she argued that number would likely to be closer to £102 billion. The solution? She felt that we should re-examine our expectations of health and social care, rather than expecting the NHS to deal with an aging population.
During the debate, the move towards private healthcare as outcomes worsen was also frequently mentioned. As more and more British people opt for private healthcare, inequality grows between those who can afford to buy services, and those who cannot. Paul Johnson, from the Institute of Fiscal Studies, argued that the NHS is already receiving a huge portion of the government’s funding – around £140 billion a year. Including spend on social care, this number increased to £220 billion. Johnson argued that the NHS is becoming an entire sector of the economy in its own right, as the NHS budget has been protected far more than other sectors such as education, police and the justice department. Yet despite this, spending per person in 2020 will be below that of 2010. Although the NHS will become more expensive to manage, the UK doesn’t face this issue alone. It is the same issue that faces all developed countries.
Perhaps the future is not as bleak as we’d originally thought. Despite all the challenges it faces, the NHS can be sustained through increased taxation. Much like the population, its problems are complex and chronic, but with improved planning and greater funding allocation, the NHS will survive.
You can listen to a recording of the event on the Festival of Ideas SoundCloud page.