Conservative Party leader David Cameron speaking in London on his party's plans for the NHS as the Conservative Party published the first chapter of its draft general election manifesto, Jan. 4, 2010.
"The NHS Must Change and We Must Not Be Afraid to Say So"
December 30, 2009
Author: Azeem Ibrahim, Former Research Fellow, International Security Program, 2008–2010
Belfer Center Programs or Projects: International Security
No wonder we Brits have so much affection for the NHS: whether you are rich or poor, if you have something wrong with you, you can get it checked out and get world-class treatment. Because we all share the payment for healthcare through taxes, we don't have to worry about being able to afford it. Even if we grumble about it now and then, that reassurance is the main reason why most of us feel a certain loyalty to the health service.
The problem is that if we are not careful, we might end up paying for that loyalty ten or twenty years down the line. In the next decade or two, the NHS is going to face some severe challenges.
The first is more old people. Imagine a room containing a representative sample of the British people. In the twentieth century, you would walk into the room and find a good balance of ages, but that is changing. Last year, for the first time, you would walk into the room to find more pensioners than under-16s. In 2025, half the people in the room will be over 50. Not only is the post-war baby boom working its way through British society, but the boomers are going to live longer than previous generation. They will need more healthcare per person than the NHS budgets for at the moment.
The second problem is less money. The NHS is likely to face a funding reduction of £8-10 billion in real terms between 2011 and 2014, according to the NHS Confederation. It also says that even after 2014, the NHS' budget might carry on declining. It accepts that "the NHS will not survive the impending spending squeeze unchanged."
The third problem is a set of chronic public health issues. The unsurprising revelation that young Brits drink more than their continental European counterparts hit the headlines two weeks ago. We do not help ourselves by not regarding misuse of drugs as essentially a public health issue. And obesity is not to be underestimated as a public health challenge. If you walked into the room containing the sample of the British population today you would find one in four to be obese, rising to 9 in 10 in 2050. Obesity alone is estimated to cost the NHS £4.2 billion and rising.
As a country, we have not reacted to problems such as the demographic effects on healthcare in our usual entrepreneurial fashion. There is a shortage of solutions. Tellingly, earlier this year the National Endowment for Science, Technology and the Arts offered a cool £50,000 to the best new policy solutions.
Perhaps the answer to these problems will involve accepting that the NHS should be what Nye Bevan set it up to be: a safety net to ensure that nobody goes without healthcare, not the only provider of healthcare for everybody. We should see the rich taking private insurance as a socially useful saving of public resources. Schools may benefit from having classrooms which benefit from having pupils from a variety of backgrounds, but the same is not true of hospital wards. We should also look beyond our borders at what other systems do well, and how best to implement them alongside the NHS here.
I'm not a politician; I'm not required to pretend I have all the answers. But anyone managing a business with comparably rising costs and falling revenues should at least be able to take the first step: admitting that things cannot carry on as they are. The NHS will not be able to give more people with more ailments more care with less money. In ten or twenty years time, I fear we will look back at those who argue that Britain need not think outside the NHS-shaped box as short-sighted victims of the conventional wisdom.
Azeem Ibrahim is a Research Scholar on the International Security Program at the Kennedy School of Government at Harvard University, a World Fellow at Yale University and the Chairman of ECM Holdings.
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