Here’s an uncomfortable fact for you. Did you know that the
unit cost of providing healthcare is rising at the rate of 9-10% per year?
That means that for the NHS to deliver the same standard of healthcare next
year as it has this year it will either have to spend 9-10% more or find ways
to work 9-10% more efficiently. The alternative is that the quality or amount
of care provided by the NHS will shrink by the same amount. This is a policy
fact, not a political point. It cannot be made to disappear by a rousing speech
about “saving
our NHS”.
For whatever reason, the British are squeamish about
discussing the cost of healthcare and even more so about discussing the ways in
which it can be delivered. It is the ‘state
religion’, as one ex-Chancellor quipped. As I have found to my cost on a
number of occasions, if you raise this question in polite society you are accused
of wanting to sell the NHS and to leave the poor to die of Victorian diseases.
The problem is that the question is real, and that response simply ignores it.
By far the most popular policy would be to simply increase
health spending by the required amount. Well, the NHS currently costs
around £100bn per year. So that means finding £110bn next year, £121bn the
year after and so on. Because the costs are rising so much faster than the
general rate of inflation (around
3%), eventually the money to do this runs out. That’s pretty much the point
we are at now, what with that massive unsustainable public deficit that people
keep banging on about. The increased spending option no longer exists.
A different route, which was half attempted earlier this
year by the coalition, is a structural change in the way healthcare is
delivered. Suppose that instead of the government being the provider of
healthcare (e.g. actually running the hospitals) it was simply a purchaser? In
theory*, private companies would compete against each other to provide the cheapest
and best service which the government would then pay for. It would still be
free at point of use, so nobody would be denied healthcare because they were
poor. How could anybody object? Well
they did, and all because they heard the words ‘private’ and ‘NHS’ near
each other. I put it to you that this is not a rational way to make policy, and
is storing up even bigger problems for the future.
My general point here is that there is a very real need to
address the challenge of healthcare costs today, particularly as we have an
aging population which is going to make it even more expensive to deliver
healthcare, and require it to be funded by a relatively smaller tax base. When
you hear a politician say that they will ‘defend the NHS’ or keep it ‘free of market forces’,
ask them how they will address the cost problem. I bet you they have no answer.
Well, we need one, and we need it soon.
*In reality this might not work quite so smoothly, for a
number of reasons that I don’t have the space for here. If you are interested,
let me know and I’ll write a separate post on the subject.