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NHS Finance

Opening the NHS Bill Book

In recent years, newspapers have been bombarded with accounts of NHS financial deficits. For those who didn’t pay too much attention to it, here is some more concrete evidence:

2015 headlines:
“Telegraph”: NHS faces the worst financial crisis in its history
“Independent”: The financial meltdown of the NHS in one chart

2016 headlines:
“BBC”: Mind the NHS financial “black hole”
“Guardian”: The NHS cannot escape its financial crisis without more money
“Daily Mail”: NHS funding black hole triples to £2.5billion… but officials are accused of ‘cooking the books’

These being the most popular newspapers in the UK, they allow us to see that the future of the NHS is indeed quite bleak. Certainly, we would not want to simply know about it. Empty words do not solve the issue.

In order to solve anything, we must first understand the reasons to this financial crisis.

 

Political and economic reasons

Despite the traditional view that doctors belong to another sphere of life, which is separate from the sphere of political battle and money, this assumption has been proved to be incorrect recently.

Since those Brexit days, and the false hopes that Nigel Farage has entrusted to the UK citizens regarding the NHS, the NHS became more negatively affected by politics and economics by the day. A good example would be the consequences that come from a prolonged reduction in the value of the sterling (due to political and economic uncertainty in the UK), which has caused the NHS to suffer from higher costs. So, if there is another economic shock in the UK, we should anticipate an even worse crisis…

 

Economic and demographic reasons
Ageing population has been a growing problem in many countries. UK is not an exception to the rule either: in an article published by the Telegraph, it mentioned that “More than one in 12 people in the UK will be aged over 80 by 2039.” Accompanying the growing number of elderly is an increase in the prevalence of chronic conditions, such as Alzheimer’s and Parkinson’s, which are diseases that add to the NHS bill, so as to provide adequate treatments and medicines.

Despite increase in demand, there was not an equivalent growth in funding, which explains why NHS was put in huge financial pressure.

 

 

Human resources reasons

Due to the aforementioned reason about the increase in population, more staff has to be recruited to deal with the rising demand, which translates to higher cost for the NHS. An increase in the intake of hospital personnel have also been fuelled by the Mid Staffordshire incident, whereby quality of care was severely impacted due to low staffing levels.

Yet, there is no guarantee that staff will want to stay once they work for a certain period of time (Long, unsocial working hours; high stress, etc.… but of course, there are many perks as well, such as the joy when you help patients recover). Without sufficient staff, the NHS had to turn to locum staff, which are temporary staff that belong to an agency.

Theoretically, locum doctors do no harm to the NHS. Yet, these private agencies, driven by the profit-making mindset, drove up prices. “In the first six months of 2015, NHS care providers spent £1.8bn on contract and agency staff – almost double what was set aside in the budget.”

 

Vicious cycle reasons
What normally jumps to mind when faced with a budget deficit would be to cut spending. However, for this scenario, it actually worsened the situation at hand. With cuts in areas such as social care and public health, it caused more incidences of “delayed transfers of care” (i.e. bed-blocking). This could be because of delays in onward care, which could be NHS community hospitals, or social care in a residential home.

So, now that we have identified the major reasons, we could start to think about strategies to tackle them one by one.

 

References:

http://www.kingsfund.org.uk/publications/deficits-nhs-2016
http://www.express.co.uk/news/uk/609500/Junior-doctors-contract-changes-campaign-locum-pay-packet-wages
http://www.kingsfund.org.uk/topics/measurement-and-performance/delayed-transfers-care-quick-guide
https://www.theguardian.com/society/2016/feb/11/are-locum-doctors-and-nurses-really-bankrupting-the-nhs

 


A Digital Solution

There are a lot of potential solutions to deal with the financial crisis. A quick one that comes to mind is what the UK government did recently to tackle the expensive-locum-uptake problem: a cap was introduced onto the hourly wage rate and subsequently tightened. However, there are two major limitations to this strategy.

  1. “There is a ‘break glass’ provision for trusts that need to override the caps on ‘exceptional safety grounds’.” Whilst this exception is well-founded, it could potentially lead to some locum agencies to abuse the system.
  2. It doesn’t solve the underlying problem of a shortage of staff. This was why they had to hire temporary staff in the first place.

Before anyone protests before the Monitor and the NHS Trust Development Authority who came up with this plan, it is important to realise that a lot of strategies in the real world are also quite short-sighted and aim to achieve a short-term goal and not solve the real reason behind it. Fortunately, this point was picked up by other institutions. For instance the NHS Pay Review Body wrote in a report that “the NHS will not solve the problem of reliance on agency staff until it solves its wider workforce planning issues’.

Echoing those words, in order to free the NHS from the deadly grasp of its budget, a cost-effective, long-term solution must be proposed. However, to come up with a novel solution, time and money are required, both of which are already a problem in this scenario. Would it help if we use strategies that are already around us?

A simple solution turns out to be nearer than we thought. In fact, it is encompassed by the very PC/laptop/smartphone you are using to read this series.

Technology.

Let’s take a look at how technology can help solve some of the issues in the NHS.

 

Ageing/Growing population

Technology can be used for primary, secondary and tertiary prevention.

Primary prevention is to preserve health, which includes apps like Health on iPhone, which tracks sleeping patterns, the amount of activity you do per day, etc. There are also apps that track your diet and analyse your nutrition. In the long term, it allows users to be more aware of their lifestyle and its relationship with potential diseases (obesity, diabetes, etc.)

Secondary prevention is to reduce disease risk and enable its detection and treatment as early as possible. In recent years, there is a surge of activity in the biosensors market, which can enter the body to a specific location to monitor a specific organ. This not only raises awareness for the individual, but in the long term, it may also allow researchers to know more about ageing through the biological data collected.

Tertiary prevention is to control or slow down disease advancement. Technology can be seen in this area as well, for instance, glucometers that are linked to our PCs for diabetic patients.

 

Staff shortage/A&E queues

Telemedicine has been a heated topic in recent years and this simply refers to the monitoring of patients’ health conditions using mobile technology.

How telemedicine can help with A&E queues is neatly summarised by Dr Provan, senior lecturer in haematology at The Royal London Hospital, Queen Mary’s School of Medicine:

“This could be used for patients with chronic disorders, such as diabetes and heart conditions, where all that needs checking is heart rate, blood pressure, weight and oxygen saturation. This could be used on apps on Androids and iPads, so the patient can keep a daily log which goes off to the centre looking after them.”

Telemedicine is equally as powerful when dealing with staff shortage, especially primary care shortage. Again, a quote by Dr Nettleman,  the Dean of Sanford School of Medicine, summarises the power of this technology:

“If there are areas that can’t support or can’t recruit a physician, technology has helped us quite a bit, it might be possible to put a physician assistant in one of those communities and have them hooked up and backed up to such an extent that they could handle preventive medicine.”

Indeed, technology seems to be a decent solution to the NHS crisis, but is NHS in the position to implement this?

 

References:

http://www.kingsfund.org.uk/blog/2016/03/nhs-agency-staff-spend
http://blogs.lse.ac.uk/politicsandpolicy/can-technology-save-the-nhs/
http://www.fiercehealthcare.com/special-report/leverage-technology
http://www.ncbi.nlm.nih.gov/books/NBK97353/
http://www.computerweekly.com/feature/Telemedicine-in-the-NHS-The-benefits-and-costs-of-implementing-telecare-services

 

About the Author:

I'm a medical student at Cambridge University, and one of the co-founders of 6med. I created the BMAT Crash Course and Interview Crash Course, and helped code BMAT Ninja and UKCAT Ninja. If you need a hand with anything, feel free to give me a shout!

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