Improving productivity is the key to saving the health serviceby Jennifer Dixon / September 7, 2017 / Leave a comment
The NHS is about as old as India since independence and the Chinese Communist State. Next July it turns 70. Celebrations will be a mix of warm sentiment, rightful pride and soul searching as to its future. But how to navigate the gush of facts, alternative facts and emotion? Is the NHS in a “doom loop” of out-of-control demand and costs, or in good health but with a short-term cold?
Clearly there are problems. The squeeze on funding growth, particularly since 2010, is real and hurting. In England the average real growth of 1.2 per cent this decade is around a quarter of what the NHS is used to. Ironically the biggest funding pinch comes in anniversary year 2018. Unsurprisingly the cracks are showing: workforce shortages, hospitals full to bursting, longer waits, tighter eligibility for care, poor access to mental health services, and scanty investment in infrastructure. Add to that the effect of cuts to social care, particularly on older frail people, and the mix is toxic. Over the last 20 years health care spending in the UK, as across the OECD, has outpaced GDP growth, and is a rising share of public spending.
Given all this, the question of how we can best finance the NHS will be hotly debated as we move into that anniversary year. But there is another question which must be addressed—one less widely considered, but which is just as important. How can we improve the NHS’s performance to cope with lower growth, if GDP growth is anaemic? In other words, how can we improve the productivity of the health service?
“Health systems using different funding models show no superior performance. It would be best for countries to work with what they have”
It’s no surprise that funding always gets more air time. The main assumption is that more investment will either solve the challenges ahead, or at least kick them down the road. The most pressing issue for the NHS is how to secure more investment for social care. For the NHS itself various options will be argued for: new patient charges, like £10 to see the GP; hypothecated taxes; changing the funding model completely, for example through employer-based social insurance as in Germany or The Netherlands; or encouraging the well off to go private and relieve pressure on the NHS.