In February 2017, the BBC published an analysis of the issues facing
the NHS.
The NHS sees one million patients every 24 hours, and is the fifth biggest
employer in the world with 1.7 million staff.
Funding
Last year UK health spend was £140bn - more than 10 times
as much as 60 years ago (adjusted for inflation). In 1955-56, it was 11.2% of the public purse, while in 2015-16 it was 29.7% (so today 30p out of every £1 spent on services goes on health). So why is the NHS is still at
crisis point?
Targets
Achieving or missing the four-hour A&E target doesn't tell you about the quality
of care - how quickly you get pain relief or whether the unit is good at spotting
the signs of a heart attack. Instead it's a sign of whether the system is under
stress - both in the community and in the hospital. When the numbers arriving
and leaving balance, then 95% of patients will be dealt with in four hours. This target was last met in England was in summer 2015, with performance worse in Wales and Northern Ireland, but Scotland is performing
a little better at around 90%.
An Ageing Population
This major factor is one that all health systems in the world
are struggling with. People are living longer; life expectancy is 13 years longer than when the NHS was created. Infectious diseases are less of threat; heart attacks claim fewer lives early, and half of those diagnosed with cancer now survive for a
decade or more.
With people living with a growing number of
long-term chronic conditions - diabetes, heart disease and dementia – for care is the issue. By the age of 65, most people will have at least
one of these illnesses. By 75 they will have two. The average 65-year-old costs
the NHS 2.5 times more than the average 30-year-old. An 85-year-old costs more
than five times as much.
Drugs
The cost of new drugs is rising. The health service is
currently considering capping the amount it will pay for new drugs at £20m each
a year. A fifth of new treatments cost more than this.
Obesity
A third of adults are so overweight they are risking their health
significantly.
Health inflation
The cost of providing care outstrips the normal rise in the cost of
living across the economy, which is why health has tended to get more generous
rises than other areas of government spending, through a combination of economic growth, which brings in more money through
tax, and reducing spending in areas such as defence. The actual amount varies with economic cycles. Since the NHS was created in 1948,
the average annual rise has been just over 4%. During the Labour years under
Blair and Brown this was closer to 7%. But since 2010 financial settlements
have been tighter.
How the UK compares with other EU countries
The UK spends less as a proportion of GDP (a
measure of the size of the economy); current ranking is Sweden, France, Germany,
EU average, UK, Spain. The result is fewer beds, doctors and nurses per
patient in the UK.
Some of these countries achieve
that by taxing more – would this work for the UK? A poll by Ipsos MORI for the BBC shows people are split, with 40% backing a
rise in income tax and 53% supporting National Insurance going up. A majority
were against charging for services or moving to an insurance-based model.
Spending or raising more money would not lead to an
overnight improvement. More doctors and nurses would need training and that
takes time and, crucially, there is not a flood of people wanting to work in
key posts. Trainee posts for GPs are being increased, but the NHS cannot fill
them all.
Structure
Is the structure of the NHS is right for 21st Century healthcare? The
NHS is still centred on the network of district general hospitals from the
hospital building boom of the 1960s. But people struggling with
chronic illnesses need support in the community, for which there is a serious
shortage, with district nurses numbers in England cut by 28%
in the past five years, while getting a GP appointment is becoming increasingly
difficult.
So more people end up going to hospital, with A&E visits rising by a third in 12 years. While not all is due to chronic conditions, they tend to be cases that take the most
care. Two-thirds of hospitals beds are occupied by the one-third of the
population with a long-term condition.
Attempts to place more emphasis on care outside hospital inlcude NHS
England's five-year plan to create more integrated care, which
involves hospital services working more closely with their local community
teams, with similar moves in Scotland, Wales and Northern Ireland. There
also an emphasis on prevention - getting people to be more active, eat better
diets and drink less.
Social Care
The biggest problem is council-run social care: day centres, help in
the home for tasks such as washing and dressing, and good quality care in care
homes during the final years of life. It is seen as essential to keep people
well and living independently - and out of hospital. But in England over the
past four years, the number of older people getting help has fallen by a
quarter, with large numbers going without care or having to pay for it
themselves. In Wales home care is capped at £60, is free for the over-75s in
Northern Ireland, while Scotland provides free personal care (washing and
dressing) in both care homes and people's own homes.
But if you were setting up a health and care service today, how would
it be done? Would you separate medical care from personal care, with one run by
a national institution and the other by local councils? Would you provide one
free at the point of need and charge for the other? Would you increase the
budget of one, but cut the other?
Would you build more than 200 hospitals and spend over half of your
budget on them when the biggest users of care are people with long-term
illnesses that need care rather than medical intervention? However, that is the
system we have got at a time when money is limited, so we are falling back on a
typical British trait - making do.
Source: BBC News website 10 charts that show why the NHS is in troubleby Nick Triggle: published on 8 February 2017
