There have been a lot of emotive statements being flung around regarding the NHS recently, so here are a few facts and a couple of questions for discussion. The UK NHS is one of the largest employers on the planet with 1.7 million employees. Only the Chinese Peoples Liberation Army, Wal-Mart and the Indian Railways are comparable in sheer numbers. This workforce far exceeds the numbers involved in direct state provision of healthcare of any other state on the planet. When set up in 1948 the NHS budget was approximately £9 Billion in todays money. The Budget was approximately £109 Billion for 2012/13 set to rise to 133 Billion by 2015. Broadly in line with any other rich western country. This represents approximately 7% of the UKs entire GDP (approx 3% in 1948). Compared to 5% for education and a mere 2.7% to defend our Islands. Only the pensions budget exceeds NHS spending at 155 Billion Approximately 8% of GDP. This is broadly in line with any other rich western country. The health outcomes provided by the UK NHS do not significantly out perform those of any other developed country, some are good some are poor, but across the board the outcomes are in line with any other rich western country, and have been over the period from 1948. So, given the above, it is I think, fair to draw the following conclusions: i) The system used to deliver healthcare is irrelevant, it is the trappings of the rich western lifestyle such as sanitation, diet, quality of housing, lifestyle and education which actually have the biggest effect on health outcomes. ii) The upward pressure on state health spending has been inexorable. Real spend and % of GDP appear to increase in pretty straight lines across all Western Democracies. Questions: 1 Given the steady rise in the population needing ever increasing care, from Statins for the apparently healthy, to long term care for the Elderly, how much of GDP can safely be poured into health provision before it starts to destabilise rich western economies? 2 Given the vast numbers of people, the even vaster amounts of money and the huge vested interests involved, is it really in the interest of health service providers (state or otherwise) to actually provide good health, or is a low level anxiety about your general health and lifestyle the best solution to keep the taxation/insurance money rolling in and the employees/profit numbers high? 3 Is it reasonable that the population should expect health care systems to deliver ever improving outcomes, despite the evidence that ever increasing expenditure is producing ever diminishing returns. Of course, I could be wrong. David.
Posted on: Tue, 19 Aug 2014 10:41:20 +0000
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