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Politicians talk nonsense about NHS funding

We’re 120 days from the UK General Election, and I’m already truly fed up with hearing absurd nonsense about NHS spending from politicians of all colours.

Society is ageing. There are 3 people of working age for every person of pensionable age in the UK.1 A little over two-thirds of working age people work, so there are, roughly, 2 working people for every person of pensionable age in the UK. By 2050—within my working lifetime—this ratio will approach or exceed 1:1.

Mean health spending per annum for a person of pensionable age is currently circa £5,000. That’s exclusively health spending; it doesn’t include social care costs, pensions,2 or anything else the Government spends to support the elderly. That £5,000 estimate is rising fast, and will continue to do so.

As the proportion of the population which is of pensionable age increases, and the costs per person of pensionable age increase, this model quickly becomes unsustainable. You reach a point, within decades, when the total tax burden becomes untenable. And before anyone says “but what about corporate taxes?”: these are, of course, paid by people, be they customers, workers or shareholders (which are mostly ordinary people via pension holdings).

Of course, it’s not all about the elderly—the young are getting sicker for longer too. As one of many examples: it’s been postulated that fully 10% of the current NHS budget is spent on diabetes-related care, and the prevalence of diabetes is rising by the month.

I believe passionately in the provision of healthcare free at the point of use. But I also believe that our current model for delivering this is broken. I don’t know how to fix it. This is where I’d like politicians to put forward bold and coherent visions of alternative ways of making this work.

What do we get instead? Monkeys arguing over peanuts. Even the National Health Action Party, whose raison d’étre should be to put this on the agenda, fail to articulate anything resembling an alternative.

Over the course of her term in office, Margaret Thatcher increased NHS spending by an average of 3% a year above inflation. These years are recalled as some of the darkest in the history of the NHS due to the perception of cuts—cuts which were, in reality, simply a level of investment which did not keep up with the rise in demand. The current budget of the NHS in England is £100m:1 a 3% per year above-inflation rise is £16bn extra funding per year by 2020.

Over the course of the next five years, the NHS estimates a £30bn per year budgetary shortfall if funding rises only in line with inflation.

Consider those two figures. £16bn per year on a Thatcherite scale of investment, £30bn per year needed according to the NHS itself. How do our political parties compare?

  • The Conservative Party claimed to be increasing the budget by £2bn in 2015/16 as a “down-payment” on £8bn per year future investment. However, it emerged that only £1.3bn of this was actually new money, and was for the whole of the UK, with Scotland and Wales taking £300m between them. So it’s a £1bn increase. Whether or not the rest of the £8bn will be made from smoke and mirrors—it’s way below what’s needed.
  • Labour want to invest an extra £2.5bn per year, which—depending on the announcement—they want to spend on one of myriad things, with seemingly no understanding that money can only be spent once. Not to mention that it’s far, far below the level of investment required to maintain the NHS in any case.
  • The Lib Dems have the most generous offer: £8bn per year. Half of what Thatcher would invest, a quarter of what’s needed. They expect NHS ‘efficiency savings’ to make up the shortfall. Where do they think the NHS is “wasting” £22bn at the moment? Perhaps I’ve too simplistic a mind, but it’s hard to see how a reduction in spending of £22bn isn’t a “cut”.

All three parties appear to have reached the same conclusion as me: it is unfeasible to continue to fund the NHS under the current model. Yet instead of tackling this head on, they are arguing over whose inadequate increase is biggest. Each party is complicit in maintaining a veil over the true scale of the problem, and bereft of anything approaching a plan to address it.

I appreciate that saying the current model of delivery for the NHS is unsustainable is a great way to lose an election. It’s a problem that needs statesmanship. It’s a problem that needs cross-party exploration. It’s a problem that needs tackling by adults.


  1. The figures used in this post are intentionally rough and ready. They’re based on national statistics, but aren’t exact for a whole variety of reasons to do with stuff like rounding and comparability. I promise it doesn’t matter – the thrust is the same even if the figures are a bit out. 
  2. Talking of pensions, the entire £100bn budget of the NHS—for people of all ages—is currently matched almost pound-for-pound in state pensions. This surely cannot be sustainable. 

This 2,289th post was filed under: Health, News and Comment, Politics.

Ten statistics for International Men’s Day

прогулка

19th November is International Men’s Day. The politics of International Men’s Day are often portrayed as complex, and many people seem to be of the opinion that it’s little more than a “me too” event to match International Women’s Day, or – at worst – some sort of anti-feminist fest.

But, for a moment, put the baggage to one side. It isn’t reasonable to argue that either men’s or women’s issues are more important – both are humanity’s issues, after all. But perhaps this is a good day to reflect on some of the challenges which are, in today’s society, more greatly burdensome for men than for women – just as we do the converse on International Women’s Day.

In that spirit, and without further comment, allow me to share ten statistics on which we can all reflect today.

  1. A man ends his own life every two hours in the UK; three-quarters of those who kill themselves are men.
  2. Men are 35% more likely to die of cancer than women – and if diagnosed with a non-gender-specific cancer, are 67% more likely to die from it.
  3. 90% of homeless people in the UK are men.
  4. 95% of the UK prison population is male.
  5. Girls consistently outperform boys in education, and young men are 25% less likely than young women to get into university in the UK.
  6. Young men are more than twice as likely as young women to be unemployed in the UK.
  7. Men account for 96% of work-related deaths in the UK.
  8. In England and Wales, men are twice as likely as women to be victims of violent crime, and twice as likely to be murdered.
  9. In the UK, 40% of victims of reported domestic violence are men, yet there are few services and little funding to support male victims. As a result, male victims are substantially less likely to access professional support.
  10. On average, men die four years earlier than women in the UK.

Male generations

This 2,284th post was filed under: News and Comment, Politics.

BMA wrong to call for repeal of Health and Social Care Act

The BMA is asking members to sign a petition asking Government to repeal the Health and Social Care Act 2012. The leadership’s rationale is that the Act requires providers to compete, while the BMA believes that “collaboration and not competition is more likely to allow a greater integration of community and hospital services”.

I could not agree more: collaboration is more clearly in the interests of individual patients than competition, and collaboration seems at odds with competition. Yet I don’t think the BMA’s position should be to call solely for repeal of the Act: after all, the Act is not solely about competition. The legislation brought about many changes, some of which are working well.

For example, we are beginning to see the value of a new local authority perspective on influencing the wider determinants of health, as shown by the exemplary nominees for NICE’s local government public health award. This sort of progress can be found in many Local Authorities across England. To campaign for repeal of the Act is to surround this progress with a fog of uncertainty: repeal would reject this progress outright and move staff back into PCTs.

The Act limits the Secretary of State’s powers to intervene in the day-to-day running of the NHS. While the success of this has been questionable at best, we are beginning to see push-back against Government diktat. No one, except perhaps Lansley and Hunt, would argue that the NHS benefits from the Health Secretary holding operational control; yet repeal would reintroduce this.

The Act confers new responsibilities on NICE to support evidence-based social care. The Act provides the first (baby) steps towards regulation of healthcare support workers. The Act gives an unprecedented level of legislative support to research in the NHS. These may be small considerations in comparison to the problems of the Act, but outright repeal would (if I may mix metaphors) cast the baby and the bathwater both into uncertain territory.

How quickly the BMA seems to have forgotten the pain inflicted on our profession through restructure, job uncertainty, and redundancy. Excellent professionals left medicine — and especially public health — to pursue other careers, while others lived for years with the stress of the uncertainty of their positions. For the profession’s trade union to argue for yet another overnight reorganisation “so big, it can be seen from space” seems utterly perverse. Perhaps this is why, despite the BMA’s repeated urging, fewer than 4,000 people have signed the petition. Even if every signatory were a BMA member, this would represent less than 3% of the membership.

Repeal represents only a return to the past. It behoves professionals to put forward an alternative vision. For example, politicians refuse to discuss the threat to universal healthcare of having fewer taxpayers per patient as a result of an ageing population; yet the BMA is uniquely placed to devise a considered, collective, professional vision of the future of the NHS. To campaign only for repeal of what exists, and allow the next government propose and introduce yet another short-term model, seems to me to be a sure route to unhappiness.

The BMA should not call for repeal of the Act: this is opposition without a position. The BMA should identify the most insidious parts of the Act, and work tirelessly to scrap or rework them. But, more importantly, the BMA should thoughtfully advocate for the future health of the nation, not for a return to the systems of the past.



Versions of this post also appear on the BMA website and Medium. It's like it's hunting you down wherever you look, begging to be read.

I took the photo at the top of this post at BMA House in September 2012.

This 2,249th post was filed under: Health, Miscellaneous, News and Comment, Politics, Tweeted, Writing Elsewhere, , , .

2D: Nigel Farage

Nigel Farage

Ukip’s increasing popularity has generated acres of news coverage in the past few months. I thought I’d use this 2D post to pick two of the more thoughtful articles about Ukip’s leader.

Writing in Prospect, the magazine for which he’s associate editor, Edward Docx describes Farage’s “relentless charm” in an article with several arresting revelations. Perhaps the most intriguing, if not the most insightful, is that “close up, he smells of tobacco, offset with a liberal application of aftershave”. I found it not a little strange how much that added to Docx’s characterisation of the man. Perhaps the scent of all party leaders should become a regular feature of all political reporting.

Docx mentions Farage’s deft handling of a lack of policy detail, but in The Telegraph, Allister Heath goes a little further in taking Farage to task on the lack of coherent policy: he claims that “there are huge black holes at the heart of Ukip’s proposals”.

While these are two rather different articles in terms of tone, form and content, they do identify much the same traits in Farage, at least from the grand political point of view. Despite this, they come to utterly different conclusions: Heath argues that Ukip essentially doesn’t “stand up to detailed scrutiny”, while Docx argues that Farage can “make politics feel personally relevant again” and “show our parliament a way to recover its dignity”.

Both arguments are well worth reading.

2D posts appear on alternate Wednesdays. For 2D, I pick two interesting articles that look at an issue from two different – though not necessarily opposing – perspectives. I hope you enjoy them! The photo at the top of this post was posted to Flickr by the Euro Realist Newsletter and has been modified and used under Creative Commons Licence.

This 2,022nd post was filed under: 2D, Politics, , , , , , .


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