Saving the national health service (part 2) Funding and social care

In my first article about the current NHS crisis, I argued that we needed to look more at capacity and demand. At this time of year, there’s usually greater pressure on the NHS and specifically on A&E services due to seasonal illnesses and health threats.  In particularly we can usually expect a spike in influenza cases.  This year, we also have a COVID wave to contend with.

The NHS may appear to run efficiently to its management if the number of doctors, nurses, beds etc match demand throughout the year but demand is not steady. So, if capacity and demand balance throughout the year, then it is probable that there will be months when there will be slack in the system and there will be weeks and months when demand will outstrip capacity.  To respond to demand at its peak, you either have to over resource the NHS through the year, or you have to find a way of providing surge capacity so that you can bring in extra resources when needed.

My second argument was that we needed to pay attention to failure demand and that means we need to look at people who are ending up in hospital with potentially serious and life-threatening conditions who should not be there and would not be there if the problem had been treated earlier.  I alluded to another aspect of this in my article.  Social care.

One of the problems that the NHS are reportedly facing is that many people are currently occupying hospital beds who are fit enough to go home but who are waiting for a social care plan to be put in place. The hospital crisis is being exacerbated by the social care crisis.  A few years ago, Theresa May, in the middle of the 2017 General Election attempted, rather clumsily to address the social care crisis. However, this turned out to be an electoral disaster and so, we’ve seen a continual avoidance of the issue by the Government ever since.

So, how do we address the social care crisis?  Well at this point, we have to recognise that we cannot avoid talking about money.  Now, personally, I’m less worried than some about whether the financing for health and social care comes from General taxation or from forms of insurance.  I think there’s a lot of misunderstanding around this subject including as follows.

  1. The UK system has never been about free health care but rather about health care that is free at the point of delivery. In other words, we pay in through the taxation system so that we don’t get a bill at the hospital.
  2. Whilst we call it “free at the point of delivery”, this isn’t completely true either.  We in fact end up paying out consistently for prescriptions, over the counter medication, eye checks, spectacles and contact lenses, dental-checks and treatment.
  3. The choice is not a binary one between the UK’s NHS and US style private health care.  There are other models available around the world, though the emphasis tends to be on forms of health insurance. 

The important thing though is this.  I don’t think we really have visibility of what the real cost of health and social care is for our country with our demographics.  This is important because whilst funding for the NHS has increased in real terms over the years, measured against inflation, this does not mean that we have increased spending in a way that keeps pace with demand as the population both grows and ages.  Furthermore, when you look at other countries you discover that they do spend significantly more per person on health care. For example, I’ve seen figures suggesting that the UK spends about 9% of GDP on healthcare, the US 15%.

So, however we go about it, my view is that we need to get a true picture of the total health and social care cost per person if we are going to look after them properly from cradle to grave.  This needs to be transparent and visible to all. We then need to determine how that funding is going to be met (or accept a reduced level of quality of care).

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