How can the NHS be made more efficient?
We began this hugely complex subject by looking at the amount of money awarded to the services provided by public funding (taxes and loans) for 2023, as published by the OBR. Health and Social Care was awarded £190.1billion, about 15% of the total public spending (£1,276.2billion), which was lower than we had all expected.
We agreed that just pumping money into the NHS in its existing format wasn’t the answer: all money allocated just seemed to get swallowed up with no noticeable improvement. Len cited the Australian system, whereby there is a 2% tax levy which is earmarked and ringfenced for medical care. Bryan pointed out that the French system - a mix of public and private finance underscored with Insurance has been judged the most cost-effective and efficient system globally. The bottom line, as we all agreed, was that people must be prepared to pay more, probably through a rise in taxes.
Barbara suggested that certain ‘non-essential’ treatments should be paid for on an individual basis (possibly a means-tested sliding scale); possibly appointments to the GP should be subject to a fee, thus placing the onus on patients to determine the necessity of their request. Sue A suggested that many could not afford the fee and would be sidelined; Sue B speculated that a missing out of primary help might be false economy, with patients requiring more expensive, intensive care further on. Jenny thought that an unrealistic expectation as to what ‘we’ deserved for ‘free’ through the NHS had changed over the decades; Sue B thought that society’s demands were increasingly conflicted with a reluctance to pay for it, which weakened the strength and honesty of politicians and governments to make difficult and ‘unpopular’ decisions.
The amount of ‘waste’ was discussed, not only about out-of-date medicines discarded, unnecessary equipment, duplication of work practices (“Come in, Jacob Rees-Mogg and Elon Musk, we understand your demands of work-accountability, even if your methods are ethically questionable”). It has always been recognised as a weakness of vast, publicly-owned institutions that the motivation to produce more in a fast and efficient manner is low. But introducing private health care inevitably leads to a 2 tier system. Question: does this matter? Let those who can afford to pay, pay. But does this free up consultants, doctors and clinicians based in the NHS? Judging by the waiting lists for non-essential medical intervention, probably not. It is human to be attracted to the higher pay, the better working conditions, the more attractive work/lifestyle balance regardless of societal needs.
Bryan raised the point of staff shortages, (no point having more hospitals etc if there aren’t the staff to run them), and suggested that the training of medical students ought to be made more attractive. The subject of staff retention should be examined: if medical students have been trained here at huge costs to the taxpayer (while recognising the high fees that are demanded by universities), there should be perhaps a requirement that they work in the UK for a minimum length of time. Enforceable? Probably not.
Margaret raised the dilemma caused by ‘bed-blocking’: the problems with social care provision – both in buildings and staffing. Solve this and the freeing up of hospital beds may lessen the problems currently experienced in A&E, corridor crowding and ambulance off-loads. It requires … funding! Where from? Both the pensioners’ triple-lock and the Universal Credit benefits system needs to be re-examined; the OBR’s ‘Other spending’ (Including what?) comes in at £469.4billion (36.7%) can offer other sacrifices.
Is it wrong that someone requiring social care should be compelled to sell their house to pay for it? It feels unfair, but is it? The present funding cap is that anyone with assets greater than £22k must contribute to their care costs. Should that change? What is the problem with insisting that people who can pay, should pay, and not gripe about the loss of inheritance to family?
We have an ageing population, brought about by a vast rise in the standard of living, the eradication of disease and developing technologies that can sustain life, possibly to the point of unsustainability. There still exists a taboo about death and life expectancy, (with reference to the stumbling progress of the ‘Right To Die’ bill currently teetering through parliament), which clouds any discussion about ‘quality of life’ versus life at all costs. We have a liberal society that indulges people’s freedom (and ‘right’) to live the way we choose, regardless of the consequences of ‘picking up the pieces’ afterwards.
Our discussion covered many other issues, some more contentious than others. Every aspect of life-style choices, education, a revival of community responsibility plays a part, plus a desperate need for a strong and courageous government to implement overdue and stark decisions.
My thanks to everyone’s contribution to this difficult subject. Interestingly, the day following our discussion, Wes Streeting announced the plan to implement huge cuts to NHS personnel, after the ousting of the Chief Executive Amanda Pritchard. And since about 95% of the NHS budget goes on staff costs, this might be pivotal for future reforms. We shall see. ``
The Enquiring Minds U3A group Tuesday 24th February 2025