We need to talk honestly about the state of the NHS

7 Jul 2018

It is something that we all take for granted in the UK and it is so well revered by the British people that it has almost become a symbol of the ever-present, and the endlessly debatable concept of ‘Britishness’? I am of course talking about the NHS, which this year is celebrating seventy years of healthcare that is free at the point of use. However, creeping in the backs of the minds of those in government is the issue of how the NHS can be sustained for future generations. In the ongoing debate, a multitude of opinions and proposals concerning the future of the NHS often bring more confusion than clarity. 


At the moment, there are proposals from both the Conservatives and Labour for large funding boosts to the NHS over a set period of time. The Conservatives plan to increase spending by £20 billion, thus increasing the NHS budget to £135 billion by 2023/24. Although it sounds fine and dandy there are concerns over where this money will come from, with the government currently stating the funds will be from the 'Brexit dividend' they claim we will receive after leaving the European Union. More likely forms of funding include potential tax rises, perhaps to be announced in the Chancellor's Autumn Statement, which may go down well with the public if they are advertised as being essential for the NHS, but may also be criticised as being another surprise tax hitting those already struggling. 


Since the Tories' announcement, Jeremy Corbyn has proposed a wallet-busting £2 billion pounds more than the Tories in NHS funding, although Shadow Health Secretary Jonathan Ashworth was evasive regarding the specific percentage increase. Both pledges are welcome in order to provide the long-term safety net the NHS needs.


However, this seems to be a case of throwing enough mud at a wall and hoping some of it will stick. The NHS does need a spending increase, that is beyond question, but what should be debated in greater detail is how the money is spent in order to see a real increase in patient outcome. The short answer is reform of the NHS so that the money that is provided by the government is spent in the areas that need it most. This has been highlighted by Dr. Kristian Niemietz, who, in a recent article for the Institute for Economic Affairs, argues that although there have been undoubted improvements in the NHS over the last fifteen years, the service has fallen behind compared to our European counterparts. Rather worryingly, we regularly feature in the bottom third of league tables with regards to health provision. Niemietz points to the example of cancer survival rate graphs, which place the UK low down against other developed countries, particularly with breast, bowel, and prostate cancer. 


Furthermore, one of the issues that the NHS faces is not that it is underfunded, but that the spending efficiency of the NHS budget is not what it should be. A study by the National Audit Office in 2010 showed that whilst overall spending has increased, the productivity has decreased. Along with inefficient spending, the NHS faces a number of issues that are set to continue for the foreseeable future, the most pressing of which is the demographic issue of an aging population. The amount of money that is required to treat an elderly person over the age of 85 in the UK is close to five times as much as someone who is young, so obviously, an aging population is going to present serious problems for the NHS in the future. 


I have personally benefitted from the NHS and the service it provides, but I also had to witness my late grandfather wait in the freezing cold for six hours until a bed became available. Many others have experienced both the advantages and shortcomings of the service. If we are to maintain a National Health Service that is efficient, well-funded, and, most importantly, free at the point of use, then we must radically reform the spending efficiency of the service. Prefunding, for example, should be an option. 


Prefunding would ultimately allow the NHS to plan how future budgets could be optimized to cope with the demographic challenges that the coming years will bring. This method may ease the funding issues that we see in the winter, the most challenging period for the service. Even opening a discussion concerning prefunding will help bring about a more honest debate about how the service can be improved. Greater honesty will not change how the now seven-decade-old institution is revered. 

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