As the NHS turns 70, let’s make it our major export

‘As we celebrate the NHS here, we must not underestimate its symbolism beyond our borders. As the People’s Health Movement, the global network of health activists, made clear in evidence to my recent consultation, the health service does not just impact on the lives of people in the UK. It is a beacon of hope to millions of people around the world who are fighting for their own access to healthcare. Its very existence demonstrates that universal, publicly funded healthcare is possible.

This was always its intention. As Nye Bevan said on the day the NHS was brought into existence: “The eyes of the world are turning to Great Britain. We now have the moral leadership of the world.” Continue reading

Facts about the NHS

  1. The population of the UK is an estimated 65.1 million. 
  2. 1 in 20 GP surgeries have closed or merged since 2013. 57 closing down in 2016 alone.
  3. The NHS England budget is £117 billion for 2016/7 and will rise after inflation to £120 billion by 2019/20. 
  4. Every 36 hours the NHS will treat 1,000,000 patients. 
  5. Accident and emergency departments recorded their worst ever waiting times in 2016/7.
  6. Hospitals recorded their worst ever waiting times for elective surgery in 2015. 
  7. The NHS in England has 149,808 doctors, 314,966 nurses, and employs 1.3 million people. 
  8. 19% of NHS staff and 29.5% of NHS doctors are non-British
  9. The average age of recent migrants to the UK is 26.
  10. Healthcare costs change with age: a 20-year old costs an estimated £500 per year, a 65-year old £3750 per year and an 85-year old £7500 per year. 
  11. The population of the UK over 65 in 1975 was 1 in 8. Today it is 1 in 6. By 2050 it will be 1 in 4. There are 1.5 million people over 85 in the U.K today. 
  12. The NHS buys many drugs from Europe and the USA paying in Euros (€) and US dollars ($).
  13. Health tourism, foreign citizens using the NHS, costs the NHS an estimated £1-300 million per year. A new overseas surcharge recouped £289m in 2015. This is 0.3% of the total NHS budget. 
  14. Stationery costs the NHS £146m/year. 
  15. Compared internationally the NHS achieves above average outcomes, with average funding and below average staff numbers. OECD.
  16. Health costs rise each year in developed countries, above real world inflation. This is broken down into staff wage inflation, new technologies, population growth, new drugs and medical advances. 
  17. The NHS was estimated to require £30 billion by 2020 to meet predicted demand. To date, it has received £4.5 billion. 
  18. Social care is estimated to require £4 billion by 2020 to maintain current service. 
  19. The ratio of people working to those retired is called the Old Age Dependency Ratio (OADR). This was steady at around 300 retirees for every 1000 people working from the 1980s to 2006, but has now since started to rise. With retirement age changes, it will still increase by 20% by 2037 to 365.

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Investment in Health promotes while investment in Defense inhibits economic growth

Using cross-national fixed effects models covering 25 EU countries from 1995 to 2010, we quantified fiscal multipliers both before and during the recession that began in 2008.

We found that the multiplier for total government spending was 1.61 (95% CI: 1.37 to 1.86), but there was marked heterogeneity across types of spending. The fiscal multipliers ranged from −9.8 for defence (95% CI: -16.7 to −3.0) to 4.3 for health (95% CI: 2.5 to 6.1). These differences appear to be explained by varying degrees of absorption of government spending into the domestic economy. Defence was linked to significantly greater trade deficits (β = −7.58, p=0.017), whereas health and education had no effect on trade deficits (peducation=0.62; phealth= 0.33).

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Higher NHS spending is necessary and affordable

The King’s Fund suggest that a 3.5% annual real-terms rise in NHS expenditure, combined with the provision of ‘moderate’ and ‘higher’ social care needs free at the point of use, would bring total health and social care expenditure up to between 11 and 12 per cent of UK GDP by 2025. This compares with the 16.9% of GDP spent by the US and the 11% spent by France on healthcare alone in 2015.

If UK economic growth continues at an annual average of 2%, by 2025 GDP at 2013 prices will be around £2.2 trillion compared to £1.8 trillion in 2015, an increase of £400 billion. In 2013 terms an increase in spending on health and social care to 12% of GDP would represent around an additional £60-70 billion annual spend in 2025. Yet even with this increase in health and care expenditure, the nation as a whole would still have over an extra £300 billion to spend on all other goods and services, public and private. The King’s Fund’s recommendation is thus eminently affordable.
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Underfunded NHS needed £3 billlion “working capital loans” from government last year

The government had to lend cash-strapped hospitals a record £2.825bn in the last financial year so they could pay staff wages, energy bills and for drugs needed to treat patients.

The Department of Health was forced to provide emergency bailouts on an unprecedented scale to two-thirds of hospital trusts in the 2015-16 financial year because they were set to run out of money, the Guardian can reveal.
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Brexit: ever growing economic inequality and the public spending cuts that accompanied austerity

The outcome of the EU referendum has been unfairly blamed on the working class in the north of England, and even on obesity.7 However, because of differential turnout and the size of the denominator population, most people who voted Leave lived in the south of England.8 Furthermore, of all those who voted for Leave, 59% were in the middle classes (A, B, or C1). The proportion of Leave voters in the lowest two social classes (D and E) was just 24%.8 The Leave voters among the middle class were crucial to the final result because the middle class constituted two thirds of all those who voted. Continue reading

The great PFI swindle

In 2011, the independent researchers Jim and Margaret Cuthbert showed the
scale of the returns to investors when they analysed three hospital contracts
for Hereford Hospital, the Edinburgh Royal Infirmary, and Hairmyres in East
Kilbride.2 Shareholders are predicted to make truly astronomical gains. Equity
of just £100 invested in rebuilding Hairmyres Hospital is projected to
earn £89 million in dividends over 30 years, while half a million pounds of
equity in the new Edinburgh Royal Infirmary is expected to win dividends
of £168m and a £1,000 equity in Hereford will yield £555.7m. These high
rewards are contractually protected and underwritten by government. The
Cuthberts’ analysis of internal financial projections for six PFI schemes show
investors are expecting to recoup 12 times more than they invested. The UK
Government has ignored these findings and there has been no major enquiry.

Using investors’ own projections, the Cuthberts calculated how much profit
was predicted from the six schemes and found that £42m of “subordinate debt”
invested by the companies building the six schemes was predicted to yield £517m. The profits on the £717,297 put in as equity by shareholders were projected to reach £350m.

Click to access TJF_2015_11-1.pdf

Click to access c_invest-JimandMargaretCuthbertsubmission1.pdf

 

NHS doctors’ open letter

After five years of a government which pledged to protect the NHS, this election campaign makes it timely to assess its stewardship, since 2010, of England’s most precious institution. Our verdict, as doctors working in and for the NHS, is that history will judge that this administration’s record is characterised by broken promises, reductions in necessary funding, and destructive legislation, which leaves health services weaker, more fragmented, and less able to perform their vital role than at any time in the NHS’s history.

In short, the coalition has failed to keep its NHS pledges.

The 2012 Health and Social Care Act is already leading to the rapid and unwanted expansion of the role of commercial companies in the NHS. Lansley’s Act is denationalising healthcare because the abolition of the duty to provide an NHS throughout England abdicates government responsibility for universal services to ad hoc bodies (such as clinical commissioning groups) and competitive markets controlled by private-sector-dominated quangos.

In particular, the squeeze on services is hitting patients. People may be unaware that under the coalition, dozens of Accident & Emergency departments and maternity units have been closed or earmarked for closure or downgrading. In addition, 51 NHS walk-in centres have been closed or downgraded in this time, and more than 60 ambulance stations have shut and more than 100 general practices are at risk of closure.

The core infrastructure of the NHS is also being eroded with the closure of hospitals and thousands of NHS beds since 2010.

Mental health and primary care are faring no better – with both in disarray due to funding cuts and multiple reorganisations driven by ideology, not what works. Public health has been wrenched out of the NHS, where it held the ring for coordinated and equitable services for so long.

In September 2014, the Royal College of General Practitioners said that the wait to see a GP is a “national crisis”.

In England the waiting list to see a specialist stands at 3 million people, and in December 2014 NHS England estimated that nearly 250,000 more patients were waiting for treatment across England who are not on the official waiting list.

Throughout England, patients have been left queueing in ambulances and NHS trusts have resorted to erecting tents in hospital car parks to deal with unmet need.

A&E target waiting times have not been met for a year, and are at the worst levels for more than a decade; and elderly, vulnerable patients are marooned in hospital because our colleagues in social care have no money or staff to provide much-needed services at home.

Funding reductions for local authorities (in some places reductions as high as 40%) have undermined the viability of many local authority social care services across England. This has resulted in more patients arriving at A&E and more patients trapped in hospital as the necessary social care support needed to ensure their safe discharge is no longer there.

The NHS is withering away, and if things carry on as they are then in future people will be denied care they once had under the NHS and have to pay more for health services. Privatisation not only threatens coordinated services but also jeopardises training of our future healthcare providers and medical research, particularly that of public health.

Given the obvious pressures on the NHS over the last five years, and growing public concern that health services now facing a very uncertain future, we are left with little doubt that the current government’s policies have undermined and weakened the NHS.

The way forward is clear: abolish all the damaging sections of the Health and Social Care Act 2012 that fragment care and push the NHS towards a market-driven, “out-for-tender” mentality where care is provided by the lowest bidder. Reversing this costly and inefficient market bureaucracy alone will save significant sums. Above all, the secretary of state’s duty to provide an NHS throughout England must be reinstated, as in Scotland and Wales.

As medical and public health professionals our primary concern is for all patients.

We invite voters to consider carefully how the NHS has fared over the last five years, and to use their vote to ensure that the NHS in England is reinstated.
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Tories’ deception: NHS massively underfunded

The doctors’ union points out that the Department of Health’s budget to fund health in England will only have gone up by £4.5bn by 2020-21 compared to the current financial year, well below the £10bn extra the government has pledged to increase it by. …

The BMA bases its claim on joint projections by the King’s Fund, Nuffield Trust and Health Foundation thinktanks. They found that Osborne’s spending reviewlast November means that the Department of Health’s budget will rise by just £4.5bn during this parliament – to £120.9bn by 2020 – but that NHS England’s share of it to pay for frontline services will go up by £7.6bn to £108.9bn. Continue reading

NHS underfunded

In 2000 the UK spent 6.3% of its GDP on health once public and private spending is added together (this is done to take into account the social insurance schemes that exist in some countries). Under Labour this rose and by 2009 it had hit 8.8%, which was above the EU average in 2000.

But the boom years had also prompted other nations to increase their spending so that by 2009 the EU average (for the 14 other members compared in 2000) was now 10.1%.

Of course since then the global economy has had to cope with turbulent times and so spending on health has stopped rising. In the rest of the EU it has remained pretty constant, while in Britain it has fallen Continue reading

This NHS crisis is political

Over 2015, the number of national newspaper headlines featuring “NHS” alongside the words bust, deficit, meltdown or financial crisis came to a grand total of 80. Call this the NHS panic index – a measure of public anxiety over the viability of our health service. Using a database of all national newspapers, our librarians added up the number of such headlines for each year. The index shows that panic over the sustainability of our healthcare isn’t just on the rise ­– it has begun to soar.

During the whole of 2009, just two pieces appeared warning of financial crisis in the NHS. By 2012 that had nudged up a bit, to 12. Then came liftoff: the bust headlines more than doubled to 30 in 2013, before nearly tripling to 82 in 2014. Newspapers such as this one now regularly carry warnings that our entire system of healthcare could go bankrupt – unless, that is, radical change ­are made. For David Prior, the then chair of the health watchdog the Care Quality Commission – and now health minister, that means giving more of the system to private companies. Continue reading

NHS spending too low compared to EU-14 and OECD countries

Over the next few years spending on the NHS increased substantially, pushing total (public plus private) spending to 8.8 per cent of GDP by 2009. By then, however, the EU-14 spend (weighted for size of GDP and health spend, and minus the UK) had moved on to 10.1 per cent of GDP. Still, the gap between the UK and its European neighbours was closing.

Since then, however, the gap has started to widen (particularly against countries that weathered the global financial crisis better than the UK) and looks set to grow further. UK GDP is forecast to grow in real terms by around 15.2 per cent between 2014/15 and 2020/21. But on current plans, UK public spending on the NHS will grow by much less: 5.2 per cent. This is equivalent to around £7 billion in real terms – increasing from £135 billion in 2014/15 to £142 billion in 2020/21. As a proportion of GDP it will fall to 6.6 per cent compared to 7.3 per cent in 2014/15. But, if spending kept pace with growth in the economy, by 2020/21 the UK NHS would be spending around £158 billion at today’s prices – £16 billion more than planned.
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Age of Dissent: more protests in 2015 than any time since the late 70s

The year 2011 is widely viewed as the peak of protest and dissent in the wake of the 2008 financial crisis and the austerity agenda that followed it. It was the year of the Arab Spring, Occupy, UK Uncut, indignados, urban riots and anti-austerity and tuition fee protests – and in which Time magazine famously named “The Protester” as its person of the year.

Yet in the UK, protests continue to occur at a rate rarely seen prior to the global economic crisis in 2008. Indeed, 2015 seems to have confirmed the suggestion, made at the beginning of the year, that 2011 was “really only just the beginning”. …
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Shortage of Nurses gets worse

More than 10,000 vacancies for nursing posts in London went unfilled in 2015, new figures from the Royal College of Nursing have shown.

The shortage of nurses worsened last year, with 17% of all London’s registered nursing jobs vacant, up from 14% in 2014 and 11% in 2013.

The figure is much higher than the national average of 10%.

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The priority for the NHS is heathcare not balancing the books

I would add, before commenting, that Sir Amyas Morse was previously a senior partner at PWC.

Maybe that is what informs his view. I cannot, of course, be sure, but what is offered here is quite extraordinary. First there is surprise that:

Running a deficit seems to be becoming normal practice for acute trusts.

Of course it is! Why on earth would an NHS trust want to underspend the money it has been given? When its job is to provide health services why would it decide not to do that? These are not private sector activities run for gain. They are public sector services run to meet need. In that case of course deficits are what they should expect. That Sir Amyas does not comprehend that leads to doubt as to his fitness for the task given to him.
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NHS trusts are forced to take pay day loans

Some NHS hospitals are so cash-strapped that they are having to take out emergency loans to pay doctors, nurses and other staff salaries every month, HuffPost UK can reveal.

A string of NHS trusts are taking out multi-million pound loans – and having to pay interest on them to the Government – simply to ensure wages are met at the end of each month.
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The HSC Act 2012 and its terrible consequences

In addition to removing the universal right to healthcare, which has existed since 1948, the HSC Act also opens the door for charges without limit for NHS services. It permits private providers to take over any NHS services. And it allows up to 49% of the business of NHS hospitals to be private. Quite apart from the fact that the intention is almost certainly to eventually increase this percentage to 100% – ie: create a US-style insurance-based system – this will create a health system with two queues: one for the poor and one for the rich. In a cash-strapped system, a rich person with a minor ailment will be treated over a poor person with a more serious ailment. “Care will never again be according to need but ability to pay,” says Dr Clare Gerada, Chair of the Royal College of GPs. Continue reading