Why is the NHS so broken?
On 5th July – ironically the ‘birthday’ of the NHS in 1948 – the new Secretary of State for Health and Social Care, Wes Streeting MP, declared that the “NHS is broken”. He is right. But why? 4 reasons:
- People – too many
- Age – too old
- Complexity – too many complex problems
- Expectation – too high.
i.e. PACE = people, age, complexity, expectation
This is what MyHSN calls it. And we cannot cope is we cannot keep pace with PACE. Let’s go through PACE, what is it?
1. People
The numbers of people in the world and UK are growing rapidly which means there are more people that require health care.
- 2022. World population 8 billion (UK pop 67 million)
- 2050 (projected). World population 9.7 billion (UK 72 million).
Yes that is staggering, i.e. an extra 1.7 billion more people, 5 million more in the UK. These UK projections are from government data here.
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2. Age
We are living longer and therefore need healthcare for longer.
In mid-2020 there were 1.7 million people in the UK, aged 85 years and over, making up 2.5% of the population. By mid-2045, this is projected to be 3.1 million, i.e. 4.3% – nearly double, yes.
The older the person, the more likely it is that they have multiple health issues and care needs. Therefore the need for social care – (whose funding is not protected like the NHS) is increasing, and will increase more rapidly. This is not helped by the fact that most UK people don’t or can’t look after their frail elderly in their own homes. Care is not free, nor are residential homes.
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3. Complexity
Of these extra illnesses, more of them are more complex (and disproportionally affect older people).
And, as medical science advances, more of them are now treatable.
In other words, not only do we have more illnesses (and more complex ones), medical science keeps finding new (and more expensive) treatments for them. Such complex diseases include kidney dialysis, heart and brain surgery, and cancer. Doctors find these interesting, so ‘push’ funding there.
The NHS has a separate funding system called ‘specialised commissioning’, for these complex diseases. Since 1948 (when the NHS started), this has been protected (‘ring-fenced’) compared to other funding – which is not logical or fair.
And it is therefore taking an increasing proportion of the NHS budget, which reduces resources available to more common cheaper diseases (and needs) – e.g. cataracts, hip replacements, skin problems, GP and mental health care. Doctors find these less interesting, so do not tend to shout much for them.
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4. Expectation
People expect more in their lives now.
They expect more holidays, travel, dinner out, takeaways, stuff etc. Our parents did not go on foreign holidays, or had meals out or delivered, all the time. The same is true for healthcare. People expect all their needs to be dealt with – as well as all the costs of social care. A greater proportion of the more people are older (with more complex illnesses), and we expect all that to be dealt with easily by the government.
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Other stuff
Does the NHS need more staff, money and stuff?
The obvious answer to such a huge problem is ‘we need more staff, money and stuff’. But latest OECD data in 2022 – that compares various aspects of society in European developed countries – does not suggest that is true.
Perhaps it suggests a few more doctors are needed. In most other parameters, we are mid-table. Unfortunately we do not seem to be really tip top at anything; either staffing and funding, or more importantly, outcomes.
Even if it is true the NHS needs more resource, in a democracy we pay for (and are) the government. However we do not seem to want to pay more tax for the government (us) to spend on us. So what can be done? Do we accept just this situation as a Faustian bargain?
And. If we do put an increasing proportion of our taxes into healthcare, which areas get less? Education, judiciary, defence, transport?
Solutions
Is it all doom and gloom? No way. We at MyHSN are very positive. The human race is clever, imaginative and determined. We have dealt with worse in the past. We can fix it. Not easy, but definitely possible. How?
Solutions not problems. We have another page with MyHSN’s 5 big solutions. You may find it interesting.
Your view
What are your views on why the NHS cannot cope? We would like to hear them. Please tell us.
Summary
We have explained why we (at MyHSN) agree with Wes Streeting that the NHS is “broken”. We cannot keep PACE with demand from increasing numbers of older people with complex diseases and social needs – and a greater expectation to have them treated and sorted.
But other developed countries (e.g. Netherlands) have the same problems and can keep PACE. So it is possible. They have a different funding system (called social insurance; Dutch version explained here) but it costs the same as ours (i.e. about 10% of GDP). We think the time has come for the UK to copy it. Minor change will no effect.
How are you going to help rebuild it?
