The National Director of Clinical Quality and Efficiency of the NHS, Professor Tim Briggs, today stated that the NHS must put its house in order before seeking more money from the government. Professor Briggs told the Times (£): 'I do not think at the moment we deserve more money until we put our house in order and we actually make the changes that will improve the quality of care'. He continued by saying: 'If you could get the infection rate across the country down to 0.2 per cent just in hip and knee replacements, you'd save the NHS every year 250-350 million pounds by improving the quality of care'.
This is the second time in as many weeks that a senior figure has pointed out that the cure for the NHS's ills is not an injection of cash. For example, Sir Mike Richards, the outgoing head of the Care Quality Commission, last week stated that the NHS does not necessarily need extra funding to improve care and patient safety.
Sir Mike's assertion that 'there are a lot of things that can be done without money' is a refreshing change from the incessant claims that the NHS needs extra funding. Increased funding has been seen by politicians and commentators from all sides as a panacea to cure our ill and ailing health service. The funding for the NHS comes from taxpayers and so it is essential that it is spent wisely, as Professor Briggs himself stated that the NHS had to ensure that:
'Every pound of taxpayers' money was spent to the best effect. Then, once we've got that, we can speak to the politicians and the population about whether the NHS needs more money. But at the moment there are significant changes we can make to improve our practice that will allow us to do a lot more work with the money we have'.
Healthcare is vitally important and people are right to be concerned about the NHS because it is not in good health. International league tables frequently rank the NHS near the bottom in terms of health care quality. Moreover, the UK ranks 19th out of 23 for mortality amenable to healthcare and 20th out of 24 developed countries for cancer survival. The failings of the NHS are perhaps best summed up by The Guardian's reporting of the Commonwealth Fund study: ‘The only serious black mark against the NHS was its poor record on keeping people alive'.
The NHS is on life-support, but more money is not the correct treatment. For example, Scotland spends more money per capita on healthcare than England, but it also has longer waiting times for appointments and the response times for ambulances are also longer.
Both Professor Briggs and Sir Mike are right to point out that funding is not necessarily the issue; what matters is how the money is spent. As Sir Mike put it: 'it is absolutely vital that when the NHS gets more money it uses it wisely'. Professor Briggs and Sir Mike have rightly diagnosed the main problem facing the NHS: inefficiency. For example, the UK comes 24th out of 30 high and upper/middle-income countries for the efficiency of their healthcare systems. Furthermore, a report by the National Audit Office found that even though funding for the NHS has increased, productivity has decreased. The head of the National Audit Office said:
‘Over the last ten years, there has been significant real growth in the resources going into the NHS, most of it funding higher staff pay and increases in headcount. The evidence shows that productivity in the same period has gone down, particularly in hospitals.’
A frequently used - and completely misguided - rejoinder to this is that because the UK spends a lower proportion of GDP than other countries, it is actually very efficient. This response is wrong for at least two reasons. First, although the UK does spend a lower proportion of GDP than some other countries, the difference is, in many cases, negligible. Second, it is also the result of a poor handling of resources. This point is articulated by Kristian Niemietz at the IEA:
‘The UK spends less on healthcare than many other developed countries, but this must not be mistaken for a sign of superior efficiency. It is mostly the result of crude rationing: innovative medicines and therapies that are routinely available in other high-income countries are often hard to come by in the UK. Any country could keep healthcare spending in check by simply refusing to adopt medical innovation. In more sophisticated estimates of health system efficiency, the NHS ranks, once again, in the bottom third.’
The NHS is sick, but more money is not the remedy. As Professor Tim Briggs and Sir Mike Richards have both pointed out, the NHS must first address its efficiency problem.
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