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An Inconvenient Truth

Posted on 1/09/2017 by David Rennie

H1 Healthcare's Managing Director, Alan MacKenzie, looks into suitability of the modern day NHS using demographic and employment data rather than attention grabbing headlines...

When health secretary Aneurin Bevan launched the NHS in July 1948 at Park Hospital in Manchester (Trafford General Hospital today), it was the climax of a hugely ambitious plan to bring good healthcare to all. For the first time; hospitals, doctors, nurses, pharmacists, opticians and dentists were brought together working under a single organisation to provide health services that were free for all at the point of delivery.

Back in the swinging sixties, our NHS service was regarded as second to none on the international stage as the ideal model for the effective delivery of (mainly) state funded healthcare, that was accessible to all. 
One never heard of hospitals in crisis, long waiting lists, bed blocking, queues in A&E, hospital closures & rationalisation and medical negligence claims.  Since then, things have changed a lot; Elvis Presley and the Beatles are not topping the charts and neither is the NHS, in terms of its perception in the league tables. However, we need to examine the landscape in which the NHS is being asked to perform.  

In the last 50 years the demography of the UK has changed considerably.  If for example, we look at Scotland, for which we have the recently published GP demographic and age analysis; we can see …  
Since the 1961 census the population has increased to 5,676,100 by 497,100 of which 458,500 (92%) are 65 or over and this is an increase of 84% since the 1960’s. The 65 to 79 age group has increased by 292,000 (63%) to 756,000 and the over 80’s have increased by 166,400 (196%) from 85,000 to 251,400.  

Back in the 1960’s, for every retired person, there were roughly 6 people in employment, paying taxes and national insurance to contribute in part to the NHS. Currently that number has reduced to 3.8; a drop of 2.2 or 37%. In fact, the ratio of employed to retired has dropped consistently by 0.2 every decade since the 1980’s in Scotland.  Since the 60’s the average lifespan in the UK has increased by 14% from 70.9 in 1961 to 80.9 today, (in Scotland it is 1.9 years less than the UK average and 2.2 years less than England). 

So, what does this all mean?  As I see it, within less than 40 years, we will face a situation where the ratio of employed to retired will have halved from 6:1 to 3:1.  The number of people who require prolonged end of life care for chronic conditions will have increased by several 100% and the length of time they will require end of life care for, will more than double.  

The implications are obvious; we have to change the way in which our NHS healthcare is funded; because we cannot expect a continually reducing working/retired ratio to fund the care of an increasing number of retired, with the added burden of their state pension funding to be considered.  In addition to the above issues, we also have to consider the ever-growing costs of medical technology and treatments and an expectation on the part of the general public that high standards of care can always be provided, irrespective of the cost.  

No government in power wants to be the one that brings the debate to the fore and raises these concerns, inconvenient truths; it’s not vote winning, but sooner or later we will all have to face up to the fact that the status quo is not a viable option for the future health of the nation.