The NHS faces serious financial challenges in the near future and is being portrayed in the media as an organisation on the verge of collapse. What is not emphasised is that the NHS provides effective universal healthcare at a much lower cost compared to other healthcare systems.
The NHS budget for England is less than £70 billion. A challenge to save £20 billion from 2011 to 2014 was set by NHS England. Amazingly, the NHS responded with an underspend of £1.5 billion in 2012/13. Despite these increases in cost efficiency, huge challenges loom large for the NHS. Acute trusts in particular face hardship.
The NHS is being ground down but there are many ways in which we might support the NHS during this period of austerity. The following are some suggestions that spring to mind.
1. Financial support for the NHS needs to increase, not shrink. Government spending on the English NHS is shrinking from 6.5% of total GDP (2009-10) to 6.2% (2015-16).
2. The continuous 'redisorganisation' of the NHS must stop. The estimated cost of disbanding PCTs and setting up CCGs as a result of the 2012 Health and Social Care Act was £1.5 billion. Integration and cooperation rather than competition needs to be the driver for change. Unless the NHS remains the preferred provider for most aspects of healthcare, time-consuming tendering processes and marketing campaigns are likely to increase not reduce costs (with the largest cost increases seen in administration and not clinical care). When profit making services are cherry picked by private providers, acute care (which struggles to make a profit) will face further hardship.
3. We must look at how we work with the pharmaceutical industry. The NHS drug bill exceeded £10 billion in 2013. A concerted campaign across the NHS to use the most cost effective drugs (and in particular generic rather than branded drugs)could save £1 billion, for example. The NHS needs to exploit its huge purchasing power (with hospitals and GP surgeries working together) to negotiate the lowest possible prices with big pharma.
4. We must address the PFI problem. PFIs (Private Finance Initiatives) are extortionate mortgages taken out to build hospitals. Approx 120 current NHS PFI projects have a capital value of £12bn but will eventually cost the NHS £79bn in repayments. Total annual PFI repayments in 2012/13 reached £1.8bn and will peak at £2.7bn in 2029/30. At least one hospital has collapsed because of crippling PFI debt.
5. We must harness the power of technology to our advantage. At present, contracts binding the NHS to single IT or technology vendors are expensive and fraught with risk when contracts end. Open source software and hardware designs which allow compatibility across the whole NHS should be standard requirements, for example.
These are my five suggestions. What would you add to this list?
Vinod Achan is a Consultant Cardiologist and the Clinical Lead for Primary Angioplasty at the Surrey Heart, Stroke and Vascular Centre, Frimley Park Hospital NHS Foundation Trust.