When the late,great Ken Dodd sang his most well-loved song, “happiness”and made people happy he was singing about the most important thing in our lives that keeps us from needing the NHS
If I wanted to make a controversial statement without people understanding my reasoning it would be, “I think we should spend less money on hospitals and acute care”. That could be taken that I want to spend less on health in the UK but it doesn’t. It just means that I think we spend too much on getting people better and not enough on keeping them healthy
If you look at the statistics for the expenditure per head of the population the UK falls roughly in the middle of spending for developed countries. We spend nowhere near as much as they spend in the USA but large amounts of that seems to go on lawyers and accountants. So, we spend roughly the same but we spend it very differently. In almost every other Country there is a far greater expenditure on things that stop people getting ill. They put into practice the old saying, “prevention is better than cure”.
In our Country the proportion spent on getting people better is much higher. Of course, this not only means greater financial expenditure. By not helping people stay fit and healthy there is a huge cost to them in the quality of their lives. In short if we attended more to the physical and mental wellbeing of the community we could spend a lot less on hospital care.
Don’t get me wrong. If I am seriously ill I want to go to a properly equipped hospital, in good condition, where fully trained staff will look after me. I have only been in this position once when I was a hospital patient for 6 days. The rest of the time I roughly eat the right stuff; drink the right stuff both in the right amounts; take a reasonable amount of exercise and avoid drugs and tobacco. But I don’t want to go to hospital or the doctors any more than I have to and that is the same view of most of the people I meet and talk to.
Just as importantly, if I do have to have some elements of acute care I want to get out of it as soon as possible. In the 6 days I spent in the Liverpool Royal Hospital I saw all the truisms of the NHS come true in front of my eyes. Lovely dedicated staff who cared and did far more than they were paid for battling appalling bureaucracy in a place that was falling apart. I just wanted to be home for a whole lot of reasons including the fact that hospitals are inherently unhealthy place.
A few months ago, I was at a conference where I made a challenge to the audience. “How many less people would there be being treated by the NHS if everyone lived in a decent and appropriate home, in a clean, green environment; had a decent job with a few bob in their pockets left over after paying for essentials for a few treats and a couple of weeks holiday every year?”. The answer came swiftly from a senior official in Public Health England – about 40%. So, the NHS has 40% more interventions with the public than they would need to if we kept people happy.
Let’s look at that in financial terms in 2015/2016 the NHS in the UK spent £116 billion. Of that about 20% is spent on primary care and public health leaving a staggering £92.8 billion being spent on acute care. If we reduced the number of interventions by just 20% it would save approximately £18.5 billion. Just think what would happen if we were to spend that much amount of money on housing; community activity and employment creation in terms of the reductions in health and other needs.
But more importantly we need to think of that in more human terms. If we take the 4% of our 11 year olds who are morbidly obese (there’s another 26% who are obese but nor morbidly) we know that it is likely that they will suffer at least three more major interventions with the NHS with poor mental and/or physical health. We know that when they reach retirement age (whatever that might be) they are more likely to have an unhealthy, sad retirement and die early. We can predict that now which is why PHE is advertising the O…Y campaign. What starts with an O ends in a Y and after tobacco is the biggest cause of cancer?
When we look round at the wider public sector budgets we find that it is the very things that keep people in good wellbeing (that’s the term posh people use) or happiness as I call it we see that there are huge cuts. When we consider the mental and physical values of a park; a library; safe community space both open air and enclosed; free travel passes; decent air, decent meals we find that those are the ones which are being cut the most.
In terms of the pure public health budget we know that the budget has been cut by 30% since the summer of 2015. We also know that for every £1 spent on public health other parts of the health service at some time in the future incur costs of £15. So, we are not even cutting expenditure simply deferring it to a point in time when it will cost far more.
So, the essence of our policies is simple. We want to spend more on keeping people healthy. We want to move the NHS budget to prevention. We want to see the NHS working with us to get even more usage from the public assets owned by councils such as parks and libraries. We want to see pharmacists and GPs given much wider responsibilities with concomitant budgets for maintaining community and district health than the delivery of pure medical outputs.
Just think how we could link NHS and council budgets to get even greater and more focused use of assets like those parks; libraries; swimming pools; sports grounds; libraries; and community centres. All of which have been provided at a huge and irreplaceable capital cost over the decades but which are falling into disrepair.
This is a conversation that we must have. If we don’t the consequences are unavoidable. The NHS will become unsustainable no matter what promises are made by politicians about how they will put the cash in that is needed. By 2050 the NHS will take every bit of tax put in to sustain it unless we hugely increase the amount of tax we raise as a proportion of GDP.
Stopping people from becoming ill is good for the NHS; it’s good for the taxpayer and most importantly it is good for all of us. This policy proposal is pragmatic, radical and vital. It’s also common sense. Let’s have the debate to bring everyone to the point where we think that ‘prevention is better than cure”.