I've been doing quite a bit of reading on this, to add to my own family's experiences. It seems we have one of the lowest beds/1,000 people in Europe and one of the lowest in the OECD at the last count (which was a few years ago). That figure is gouing to be cut by about a third so we'll have less beds pro rata than almost every other developed nation before too long. We also spend far less as a percentage of GDP than the EU average.
Back in 2000, Blair committed us to spending at least the average, which was then 8.5% of GDP. However, by the time we got to that figure (it was 8.8% in 2009) the EU average weighted spend was 10.1% so we were still 1.3% below the curve. On current projections for GDP & NHS spending, that figure will be down to 6.6% in 2020 compared to 7.3% now. Even just to keep pace with GDP growth, we'd have to spend an additional £16bn (per year) than is currently planned.
Because of differences in funding, it's tricky to compare spending across different health care systems but one comparison is to compare on the basis of public + private expenditure. On that basis we spent 8.5% of GDP. That's about 1.7% below the EU average (excluding the UK) and 13th out of 15th of the original EU members. Ireland and Luxembourg being lower. So we're historically low spenders compared to our peers and if we want a comparable health service we have to spend about 20% more than we are currently doing.
But that has to be funded and we've three choices in essence - pay more tax, borrow more or increase private funding of medical care. Also cutting costs where possible but PFI has landed the NHS with what appears to be a ridiculous level of on-going costs for capital and revenue spending. As others have said, there has been a move to do lower-risk, lower cost procedures in the private sector, leaving the NHS to pick up the high-risk, higher dependency stuff. I don't have an ideological issue with private resources being used to provide NHS services where that's cost effective and maintains a high level of quality. The problem is that the NHS, like the education system, is an ideological football. The ideal would be a Health Commission that is independent of political control and decides and implements the strategy of providing healthcare, with a guaranteed level of funding (as a % of GDP). This will need to interface to government but not be subject to political interference.
As part of that we need to have a well-thought out approach to the key healthcare functions:
- Prevention
- First point of contact (GP, other Primary care centres, Ambulance services and Hospitals)
- In-patient and out-patient care
- Social care
We also need to accept that we may need to pay more, via higher taxes, higher public debt, reduction of spending on other things, private contributions or a combination of some or all of these. The other issue with something that is free at the point of delivery is that these things get taken for granted and there may be circumstances where some sort of rationing needs to be applied.
