NHS - the state we're in

19 September 2013

This week a BBC Radio 4 debate brought together experts from across the health service with the aim of discussing the challenges the NHS faces. We've looked at the evidence behind a selection of the claims.

By 2020, there will be a £30 billion shortfall in the NHS

According to a report from NHS England, the NHS will indeed face a funding gap of £30 billion between now and 2021. This amounts to approximately 30% of the current NHS budget.

But the estimate assumes that funding for the NHS remains flat, which means that the annual increase to its budget is just enough to absorb inflation.

During the debate Professor John Appleby from the Kings Fund described the £30 billion figure as "very pessimistic". He argued that even in the current era of austerity the government has promised to increase the NHS budget in real-terms every year of this Parliament.

The £30 billion estimate also assumes that the NHS will not become more efficient or more productive - that, for example, new and inexpensive technology will not help to reduce overheads. The Nuffield Trust predicts that if the NHS 'economy' were to grow at the same rate as the wider UK economy and if spending on healthcare increased in line with national income, the gap could be as little as £6 billion.

It's likely to be somewhere in the middle. According to the Office for National Statistics, NHS productivity has fluctated considerably in recent years. In other words, we can't assume that it will continuously increase.

The government has spent £1.5 billion on redesigning the NHS

This is the upper figure of a range quoted in the government's impact assessment. However, the Labour party claims that the cost of implementing the Health and Social Act is closer to £3 billion.

This estimate is based on the fact that Primary Care Trusts (now abolished) had been required to pay for some of the costs of transition. According to Labour's calculations, this 2% tariff amounted to around £1.6-1.7 billion per year - so over a two year transition period PCTs have been "holding back" over £3 billion "from the NHS frontline". 

However, the allocation of 2% of a PCT's budget for "non-recurrent costs" isn't anything new. It predates the Health and Social Care Act. For a full breakdown of the numbers, you can read our factcheck.

NHS care is now restricted in a way it wasn't previously

In the course of the Radio 4 debate Dr Mark Porter, chair of the British Medical Association, said that access to some NHS services had been limited. He cited IVF by way of an example.

As we've noted previously, there are certain exceptions to the principle that NHS services are free at the point of use. According to the Local Authorities Regulations 2013

"There is provision for local authorities to charge for certain services, but not those provided to an individual for the purpose of improving their health." 

This means that for certain non-essential or cosmetic procedures (such as IVF or varicose vein removal) whether someone receives treatment free of charge is essentially a local decision. In many cases a patient will be asked to pay for their treatment.

The UK has far fewer hospitals than most other developed countries

A quick look at the OECD data that's available suggests this isn't likely.

While there are figures for other countries, there are none for the UK. However, we know there are some 2,300 NHS hospitals in the UK, which equates to approximately 36 hospitals per one million people. This places the UK above the 2011 OECD average (31 hospitals per million people in 2011), although the OECD's method of counting hospitals may differ from the one we've used.

At any rate, the significance of this number is limited. After all, the number of hospitals isn't an indication of the quality of healthcare patients can expect. In the UK, the government has promoted the idea of fewer, bigger hospitals where patients will have access to a range of specialist services.


Flickr image courtesy of estherase 

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