欧博abgThe NHS is at the heart of our productivity s
If, as expected, Rachel Reeves breaks Labour’s manifesto pledge and raises income tax in the upcoming Budget, one has to question how efficiently and effectively the nation’s finances and public services are being managed.
Of note, the Health Foundation have this week published a report highlighting a slump in NHS productivity at a cost to the economy of £20bn a year. With the NHS already costing the UK economy 11.1 per cent of GDP, or an estimated £317bn in 2024, Starmer’s Government can ill afford to allow these inefficiencies to persist.
But with a health care service predicated on “free at the point of delivery”, alongside year on year increasing public demand and declining productivity, can Labour ever turn things around? Or will the NHS continue to expand its demands on the public purse, while delivering a substandard service, and requiring taxpayers to foot the bill?
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I have to admit that working in the NHS has left me increasingly sceptical about the health service’s effectiveness and sustainability. As a GP, I hear frustration from patients at their difficulty in booking appointments. I frequently have to negotiate with patients around our capacity for home visits – the day is busy, and often there simply isn’t time to get in a car to do house calls. At a previous surgery, I found I was making clinical decisions over the telephone and prescribing treatments that should only be offered after face-to-face assessment. But when resources are stretched thin, corners are cut.
Likewise, every week my patients feedback experiences from our local emergency department. They describe chaotic and undignified scenes, often involving prolonged waits to be seen.
One patient had suffered a major heart attack, but the ambulance service warned of a long delay so his wife drove him in. On arrival, they spent hours sitting on a plastic chair before eventually being admitted to an outliers ward, as there was no space on the cardiology ward. He waited over a week for critical cardiac surgery which was cancelled on four separate occasions. His wife spent time phoning hospitals all over the country to see if there were any spaces on a cardiology unit elsewhere, to no avail. This couple had private health insurance and would have been willing to pay for quicker treatment, but were advised there were no alternatives to the NHS care they weren’t receiving.
It is not until you are in a desperate situation like theirs, that you realise the perils of a malfunctioning health service. My suggestion that they write to their MP about their experience felt somewhat inadequate. MPs must be well aware of the scenarios unfolding in the NHS’s overwhelmed hospitals and GP surgeries. And yet it continues.
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The Health Foundation’s report on productivity highlights that NHS productivity was increasing in the 2010s, but fell sharply in 2020 and has not returned to its original path. It reports that the NHS has “lost around a decade of productivity growth”, with the change in trend leading to a 14 per cent loss of productivity, equivalent to approximately £20bn of additional care. Furthermore, the NHS appears to have experienced a steeper and more prolonged productivity decline than comparable countries’ health services.
My observations from the front line of working as an NHS doctor is that as the system becomes overwhelmed (increasing numbers contacting GP surgeries, or longer waits for assessment in emergency departments), increasingly inefficient decisions are made. Rather than do the best thing for each patient, the temptation is for clinical staff to choose the quickest or easiest option. This frequently leads to patient mismanagement, clinical deterioration, re-attendance and even avoidable mortality.
An efficient and effective health system needs to function within its capacity. Once overwhelmed, complex systems descend into chaos and dysfunction. The root of the issue may be that the NHS is overreaching in its attempt to deliver universal, free at the point of access health care. If GP surgeries cannot deliver timely, accessible care, and emergency departments fail to provide safe or dignified treatment, then the NHS must re-examine what it aims to deliver. Labour will find that health system failure, at ever increasing cost to the taxpayer, will never be politically sustainable.