Wednesday, September 12, 2007

 

Memo from Wanless: Answer to NHS Costs Lies in Healthier Lifestyles

According to Tom Bower's biography of Gordon Brown, Derek Wanless was less than happy when his 2002 report on the NHS was used selectively by the then Chancellor to justify doing nothing to change to the management and financing of the NHS(p379). The fact that he did not commission, as Wanless advised, another report five years hence, suggests Bower was right. So the Kings Fund kindly stepped in to oblige and the result we see all over the papers this morning; predictably, some are scathingly critical, while others more measured.

In today's Society Guardian John Carvel interviews the ex banker and we get closer to what his report is saying. He fears that, whilst the tax based system has done quite well since the injection of £43bn since 2002, the prognosis for the future is not so good. Certainly he thinks money has been spent in a cavalier fashion in terms of pay awards which carried no productivity pay-off, and constant reorganisation has not helped at all, but he praises the reduction of waiting lists and the employment of more doctors and nurses. The key thing seems to be the changing lifestyle of our nation. Frankly, as we are getting older and older we are becoming less healthy through our shocking eating and low exercise habits.

On a 'slow uptake' trajectory in 2002 Wanless projected the NHS would cost taxpayers from £68bn in 2002 to £154bn by 2022-3: a huge increase in percentage of GDP. The slightly odd thing to me is that he still supports the tax based model. It has seemed to me for some time that the French, German and even, in some ways, the Irish systems offer better service and value for money through complementing tax funding with a degree of health insurance.

This does not mean they are like the US system which is so obscenely costly that some 50 million of its citizens are not covered by any health insurance, but it does provide the extra layer of funding which makes the French and German systems at least, superior to the NHS. And if health costs require individuals to change their lifestyles, then some financial incentives in the form of lower health costs would, surely, be no bad thing?

Comments:
Good post Skip - I wish more people on the left recognised these long term trends and what they will eventually mean for the state-funded model.

Ultimately the NHS will have to change quite radically to accomodate the demographic changes ahead but when politicians from the right suggest anything other than funding via direct taxation party politics kicks in and they're accused of wanting to 'privatise' the NHS - we need a more grown up discussion than that.
 
Quite right Skip and cassilis - trouble is this is a political no go area for all the main parties.

Labour is quite justifiably proud and defensive of the NHS. As long as people on the right go on quoting selectively from reports such as Wanless's and trying to make out that the whole service is failing and/or that all local hospitals are closing and/or swarming with super-bugs, we will be stuck in shouting matches and point scoring games.

It's unlikely that a rational discussion about future funding can be held within any party at present anywhere other than behind very firmly closed doors. But I bet such discussions are being held...
 
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