Fixing the NHS?

This was an interesting post published in Financial Times:

How to fix Britain’s chronically ill healthcare system | Financial Times

While the pandemic has undoubtedly created a shock in the UK’s publicly funded health system, the NHS’s underlying issues are chronic. Waiting lists for elective treatment have been lengthening for 10 years, and the target of keeping 95 per cent of A&E waits under 4 hours missed for just as long. (These figures from NHS England are broadly replicated in Scotland, Wales and Northern Ireland: health service management is devolved.)

It would be easy to blame underfunding, but in 2019 the UK spent just over 10 per cent of GDP on healthcare, placing it among other wealthy western European countries. The trend over the past two decades has also aligned with comparable nations, according to the OECD.

Logically, we would expect inputs to correlate with outputs. With increased funding (as well as inflationary rates), users should expect “better” services, like less waiting times. However, hospitals are limited in their capacity to grow. The outpatients and triage can’t be separated (unless there is some model to account for only handling emergency cases). It is difficult to work in silos like “GP’s” because the satisfaction level is the lowest. I am genuinely surprised they will be called for surgeries, assisting deliveries, or handling fever. Albeit, it doesn’t require a specialist expertise each time, but there could be missed or delayed diagnosis too.

The author underscores this:

While the number of fully qualified permanent GPs in England has fallen by 8 per cent since 2009, that of hospital doctors has grown by a third, outpacing the growth of the elderly population that accounts for an outsized portion of hospital demandNurse numbers continue to grow despite more departures this year.

Having “nurse practitioners” is only a specific “stop-gap” arrangement.

Is preventive or residential care the panacea?

Preventive care is complex, and there are no measurable quantifiable indicators-barring the number of people attending the hospital or seeking healthcare. Residential care will require retraining/diagnostic devices that users won’t pay for, and ensure they work reliably as intended. A tall order indeed. Hiring practices in home care (like long-term care) or for palliative services is under cloud for remuneration and attendant problems with the gig economy, where health workers are forced to work without a social security net. It can’t be fixed with “more funding”, but clear policy objectives and co-pay instead of “free”.

Interesting times The impact of technology on the health sector still needs deliberation.

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