NHS must suppress demand and cut waste

The UK’s NHS (National Health Service) is widely considered to be a national treasure – it’s also the biggest employer in Europe with around 1,500,000 staff:

  • Healthcare services for all ailments are offered ‘free at the point of delivery’ (except such as dentistry, some prescriptions and eye tests ) to all UK citizens
  • Poor families, in particular, are no longer threatened with bankruptcy and abject poverty if unlucky enough to suffer serious health problems:
    • Up to WW2, they had been forced to pay doctor’s and/ or hospitals’ bills, which sometimes were huge, or go without treatment
    • Since then, the NHS ensures this can no longer happen
  • So everyone is happy if they don’t need the NHS, and happy if they do

However, ‘free at the point of delivery’ is causing immense problems

If a good or service is offered for free, most people in need will try it – but if there’s a price attached, most will first assess the value for money on offer versus their need and only then decide whether to buy it or not

Herein lies the dilemma facing the NHS:

  • Demand for its free services is forever increasing, not decreasing, over time – quite the opposite of what NHS founder Aneurin Bevan thought would be the case i.e. ‘as people become healthier, demand will fall’
  • Not only that, costs are also increasing far faster than inflation rates

Why so?

  • Average UK lifespans have increased by some 10 years over the last 70 – the downside of this major success is more people are surviving for longer so more end up suffering more old-age health problems which tend to be lengthier and more costly to treat
  • Also, an avalanche of remarkable but costly drugs and treatments have since become available to treat many more symptoms, many of which would have been borne silently in the past

Hence, both demand and costs have been remorsely rising over the period

So, with few clubs in its bag, the NHS has coped with this demand by simply letting waiting times increase viz:

  • An estimated 4.3 million people are now waiting for NHS treatment
  • More than 200,000 have been waiting at least six months for routine surgery, the first time this has happened in a decade
  • And more than 3,000 have been waiting more than a year for procedures such as hip replacements, six times as many as just five years ago

The government knows such results are unacceptable to the general public who fund the service – hence ‘something must be done’

Susan Hill, senior vice-president of the Royal College of Surgeons, says: “Six months will be too long to be waiting for treatment for some patients – it’s extremely stressful for them and their families to have to wait this long – many will be in severe pain and discomfort, possibly unable to work or carry out daily tasks”

However, waiting times, whatever the service, tend to reach a ‘steady state’ and then not rise or fall much after that:

  • The longer people have to wait to see their GP or receive treatment the more many of them look for alternative private solutions, or decide to ‘grin and bear it’ – so demand stops rising
  • Conversely, if extra money and resources are ploughed in to reduce waiting times, people soon ‘get to know’ of any improvements made, many rejoin the queues and demand thus increases
  • Either way, waiting times soon return to square one

The same perverse result occurs when new roads, especially new motorways or by-passes, are built to reduce traffic congestion – once opened, more people who used to walk, cycle or use public transport are also attracted to use them, jump back in their cars and congestion soon returns to its original state

The government’s focus on reducing waiting times is thus not the long term solution needed

NHS costs can only be constrained to manageable levels by:

  • Suppressing demand by reducing the services offered ‘free at the point of delivery’ and attaching a price to all others
  • Seriously addressing the systemic waste of resources currently experienced


1. Suppress demand:

  • It’s clear that the NHS cannot continue to offer everyone, good quality treatment for every health ailment they suffer ‘free at the point of delivery’
  • Niall Dickson, CEO of the NHS Confederation said only recently: “We have some really tough decisions ahead – we cannot do it all – and we need to admit that”
  • Hence, demand should be reduced, with public agreement, by dividing all current NHS services into two categories:
    • Free to all = Those services that restore a patient’s quality of life back up to an acceptable normal level e.g. all treatments which reduce physical and mental pain, discomfort and/or distress plus anything life-threatening
    • Cost to all = Those services that improve quality of life above an agreed acceptable normal level e.g. treatments for obesity, drug addiction, varicose veins, cataracts, unusual appearance or much cosmetic surgery
  • In other words, continue to look after the seriously ill for free, and with short waiting times, but make all others pay or seek alternative providers
  • And to deter those who abuse free services, require all people to first be checked by an NHS gatekeeper – a GP, ambulance paramedic or A&E doctor – before being admitted


2. Cut waste, increase efficiency:

The NHS costs UK taxpayers some £125 billion a year yet, when it was set up in 1948, the cost in equivalent money was £9 billion – a 14 times increase over just 70 years, and increasing every year – clearly, such rises cannot continue

At present, governments of all hues keep pouring in more and more taxpayers’ money, desperately trying to meet NHS squeals for more nurses, doctors and/ or beds – they daren’t be seen by voters to be not supporting the NHS – it would be electoral suicide

But one might question how they calculate the cash needed in their efforts to match capacity to demand given nobody has any good idea what the actual NHS capacity is

The latest figure plucked from the ether by the Tory party is an extra £20 billion per year injection by 2023 to be taken out of tax-payers’ pockets – they think this is big enough to at least trump the Labour party’s ace always played at general elections – and maybe that’s all that’s needed?

But what if extra billions were not needed anyway?

One keeps hearing about internal efficiency drives being conducted but never any big savings achieved

The impression given out is that all current resources are working to their maximum capacity, if not more:

  • Nurses and doctors are working longer and longer hours
  • Bed utilisation is over 100%
  • Work-rates are flat-out
  • The danger is increasing staff exhaustion

It may well be true that most staff are working hard and very long hours, but what if the systems they have to follow are wasteful of their time and skills – for example, how much time is wasted on:

  • Unnecessary paperwork?
  • Bed-blocking and bottlenecks as patient flow through the whole system is delayed caused by lack of coordination between each stage?
  • Infections caught whilst an in-patient e.g. MRSA?
  • Re-infections?
  • Medical mistakes?

Staff and management consultants with considerable experience on the NHS front-line both say the overall waste of resources is at least 30%

If this is so:

  • 30% of the current £125 billion NHS cost = £37.5bn wasted every year i.e. a lot more than the extra cash injection proposed
  • And, if no significant changes are made to current ways of working, then increasing NHS cash inputs by £20 billion will also increase the amount wasted e.g. 30% of £145 billion = £43.5 billion i.e. an extra £6 billion wasted

Hence, the NHS may not need the extra £20 billion p.a. after all to keep the population fit and well

So why do NHS managers keep on asking for more and more rather than seeking out this treasure trove?

It’s the ‘use it or lose it’ attitude prevalent in the public sector – if managers do well and spend less than their budget, they’re not rewarded, just receive less the following year – so the best one can expect is for them to spend 100% of their budget – hence so many hospitals are now said to be in financial trouble

Meanwhile, the general public have little idea how well their local NHS units are actually performing – they’re just hugely grateful when cured of anything – detailed performance information seems restricted to insiders only i.e. a few on the front-line and Department of Health bureaucrats

Far better for senior NHS managers to have to report at least once a year to their local community (as the police do) on their successes and failures, and how they compare with best practices elsewhere in the NHS and abroad – transparency  indeed

Otherwise, to quote Matthew Parris in an article in The Times, we’ll continue “getting a second-rate health service for the price of a third-rate one”


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