'We need to find extra £100 a head on NHS. I've heard that people pay that for a haircut'

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As the flu crisis deepened yesterday, medical organisations questioned the capacity of the NHS to cope with the growing health needs of an ageing population, aggravated by seasonal fluctuations in demand.

As the flu crisis deepened yesterday, medical organisations questioned the capacity of the NHS to cope with the growing health needs of an ageing population, aggravated by seasonal fluctuations in demand.

Doctors and health experts pointed to the widening gap between the UK and Europe in health spending, reflected in fewer hospital beds, fewer doctors and longer waiting lists on this side of the Channel.

Total spending on health in the UK is forecast to exceed £1,000 a head this year for the first time - up from £222 in 1980. More than £900 of that will go on the NHS and the rest on private care. After allowing for inflation, it is more than twice the amount spent 20 years ago.

However, we are still the paupers of Europe in spending terms, with one of the smallestbudgets among the main industrialised countries. In 1997, the latest year for which comparisons are available, the UK spent £889 per head compared with £1,205 in the Netherlands, £1,433 in France and £1,634 in Germany. Much of the difference is accounted for by private spending on health, generally higher on the Continent.

When countries are compared in terms of their investment in the state health system as a proportion of their economic wealth (Gross Domestic Product or GDP), the UK fares better. Our investment of 5.7 per per cent of GDP in the NHS in 1997 (excluding the 1 per cent spent in the private sector) is equivalent to most countries in Europe but still below that of France (7.8 per cent) and Germany (8 per cent).

The crude figures are hard to interpret because costs differ. In Germany, doctors' salaries are higher and providing a given level of care is more expensive than it would be in the UK. In addition definitions of what counts as health care differ. In Germany, spa treatments are available on prescription while in Britain they are available only from a travel agent.

Sir Brian Jarman, a prominent GP and expert on the link between healthcare provision and death rates, said the UK could no longer duck the need to spend more on health. "We spend £50bn a year on the NHS and we need another 1 to 2 per cent of GDP. If we had another £5bn that would make the difference. That works out at £100 a person. I've heard that people pay that for a haircut."

He added: "We have got a lot of money [with the economy growing]. I think we can afford another £5bn."

In a study published in the British Medical Journal last June, Sir Brian and colleagues showed that countries with a higher number of doctors had lower hospital death rates. Britain had one of the lowest number of doctors at 1.6 per 1,000 population - 60 per cent below the average for OECD countries, Sir Brian said.

Critics argue that on the standard health measures of infant mortality and life expectancy, the UK compares well with the rest of Europe, and there are therefore no grounds to spend more on health. Sir Brian is unconvinced. "We have got a pretty good service and it is cheap but we have the longest waiting lists and when you go into hospital it is pretty grotty. I would spend the extra on doctors."

The flu outbreak, which is sweeping the Continent as well as Britain, has had a bigger impact here because of the shortage of beds. The UK has one of the lowest numbers of hospital beds, at fewer than five per 1,000 population, half that of France and Germany and a third of the number in Japan.

The NHS Confederation, representing hospital trusts, complained that the NHS was running so close to capacity, at 90 per cent occupancy levels, there was no flexibility to accommodate the annual winter surge in demand. "We must stop running the system at dysfunctional levels of capacity," said Stephen Thornton, the chief executive.

Figures revealing the increased pressure on the NHS over the past two decades bear out the confederation. Between 1980 and 1997, 30,000 acute hospital beds were lost across the country, a fall of 19 per cent to 128,000. Over the same period, the number of patients treated per bed rose more than threefold, from 15 to 53 a year.

The pressure has been increased by the ageing population. Since 1980 there are a million more over-75s and 500,000 more over-85s.

John Appleby, a research fellow at the Kings Fund, the health policy think-tank, said the pressure on beds was a key feature of the scene. "There is a big difference in spare capacity on the Continent."

The question for policy makers is whether the public would be prepared to pay for a health service with extra beds and staff able to cope comfortably with winter pressures but which would be run at well below full capacity at other times of the year. The alternative would be to recognise that running a health service is a seasonal business and that flexibility has to be built into the planning.

But the price of a flexible service is that in winter people awaiting non-urgent hip replacements and hernia operations may have to wait.

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