There’s no simple reform that can reduce NHS costs
ALABOUR victory at the next elections may bring about some policy improvements, despite some weaknesses in their plans.
Wes Streeting, in particular, does not have a realistic strategy. His promised limited increase in funding for the NHS is inadequate, whilst his enthusiasm to use private hospitals to cut waiting lists is unguarded.
What was particularly puzzling was that Streeting felt the need to attack his own voters by saying that he would not be put off by “middleclass lefties” who criticise using the private sector.
It is perfectly possible to run “waiting list initiatives” in NHS hospitals: this has often been done in the past. However, waiting lists for surgical procedures requiring hospital admissions are problematic, given the chronic shortage of hospital beds: we have far fewer hospital beds than most other developed countries.
However, investing in NHS hospitals to increase the number of beds is necessary not just to reduce waiting lists, but also to meet the demand for urgent admissions. In the short-term the private sector may have to be used: no staunch NHS advocate would ever object to this.
At the end of the day, though, both the NHS and the private sector use the same limited pool of nurses and doctors. Thus, we need to fund workforce expansion, as well as an equitable pay offer that ends the junior doctors’ strikes.
The British Medical Association (BMA) has pointed out what are the downsides to using private hospitals for NHS work (Outsourced: the role of the independent sector in the NHS, 2022).
Using the private sector is not usually the cheapest option and may not be the safest. Private hospitals are good for simple procedures, but less suitable for complex cases as they do not have on-site emergency or intensive care services, or continuous access to a range of specialists.
Furthermore, increasing the use of private hospitals for high-volume low-complexity procedures starves NHS hospitals of resources and income and makes it more difficult to train new doctors and nurses, as training takes places in the NHS.
Wes Streeting is also excessively enthusiastic about “NHS reform”. Reform has often been a distraction in the past and the never-ending structural reorganisations have done more harm than good to the NHS.
The last Labour governments (1997-2010) improved the NHS with increased spending, whereas their endorsements of the Private Finance Initiative caused some serious problems.
Wes Streeting has stated that increased NHS funding might be contingent on medics increasing weekend work. This is possible to a point but increasing “out of hours” working reduces time worked during regular hours. This would affect “continuity of care”, which is an important contributor to good care.
“NHS reform” is currently being enacted with an expansion in the number of staff who have shorter non-medical qualifications, and with a shortened simplified training for doctors. The medical profession has reservations about both of these changes.
There are health inequalities when paying for private treatment is the only way to avoid long NHS waiting lists, but there would be even more inequalities if private treatment became the way to ensure being seen by experienced medical staff.
NHS spending has increased from 3.4% of gross domestic product (GDP) in 1950 to 10% in 2020 and is predicted to exceed 30% of GDP in 2090: more diseases are now amenable to treatment than in the past, but at an increasing cost.
One could argue that, as long as the GDP grows, we should be able to increase spending on healthcare, as this is a top priority for many. Others believe that public spending may eventually need to be restricted to those treatments that are most costeffective: this would be problematic.
The NHS is relatively efficient in comparisons with other health services, but increased capital spending to replace unfit buildings and outdated equipment would increase productivity.
Public health policies aimed at reducing the disease burden and patient empowerment, enabling patients to self-manage some health conditions, would help to contain the escalation of NHS costs.
There is no simple “reform” that can reduce NHS costs, we will need a combination of strategies and good political leadership.
Giuseppe Bignardi retired in 2019 as a consultant in microbiology and infection, based in the North East.