The British love the National Health Service, but it is in a mess. It was built in the 1940s for a different kind of country. Now it largely looks after a bulging population of the old and chronically ill, and is constantly short of cash. Reform is urgently needed but it has been too slow to arrive. A troubling new report is likely to drive this point home to doctors and health officials. It was overseen by a respected and straight-talking orthopaedic surgeon, Tim Briggs, and was backed by the health secretary, Jeremy Hunt. The report, on general surgery, part of a much broader review led by Professor Briggs, finds the NHS is wasting a great deal of money.
It says that 300,000 patients a year are needlessly admitted for emergency operations, and £23 million wasted on patients staying too long in hospital after bowel surgery. Some hospitals are paying much more than others for surgical supplies, and varying infection rates for hip replacements (between 0.2 per cent and 5 per cent, depending on where people go) cost the heath service £300 million. Hospitals tend to have no idea what others are doing and are surprised when told that they are behind their peers. In sum, Professor Briggs told The Times: “I do not think at the moment we deserve more money until we put our house in order.”
This argument has some merit. Professor Briggs’s report is the latest in a line of government reviews which have pointed out that there is money down the back of the sofa. In 2014 the NHS England chief’s Five Year Forward View found room in the health service for £22 billion in efficiency savings by 2020. In his 2015 report the former Marks and Spencer boss Lord Rose of Monewden concluded that the health service was “drowning in bureaucracy”. And last year a report by Lord Carter of Coles said that hospitals were wasting £5 billion on paying too much for supplies.
The NHS response has been glacial or nonexistent. But its problems are not unsolvable and it has a number of correctable design flaws. There is political pressure not to run deficits but little to invest in innovations, which means that smart new ideas do not often travel from one hospital to another. Hospitals are paid per operation so they are not inclined to cut back. Separate budgets and commissioners for different sections of the NHS (such as preventive healthcare and specialist hospital care) mean ideas that might move money from one to another are often resisted. No single person holds responsibility for smoothing out variations across the health service. The matter can therefore slip under the radar.
Any changes will require considerable political clout. The Department of Health has yet to recover fully after the botched reforms under Andrew Lansley, Mr Hunt’s predecessor. While other public services such as the police have spruced up their technology and adapted to changing needs, the NHS has remained in deep freeze. It should summon the confidence to drive through the reforms that a modern health service urgently needs.
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Professor Briggs’s project suggests that matters may be moving in the right direction. It is not just a data-gathering exercise — his team take their results from hospital to hospital, talking through how each health centre compares with its peers. Professor Briggs claims that a similar initiative from 2012, on orthopaedics, is now yielding good results.
The health service is not alone in its problems. It shares them with most of the world’s healthcare systems. This year’s Commonwealth Fund survey found Britain’s health service to be the best, safest and most affordable of the 11 countries that it analysed. The NHS is also one of the biggest organisations on the planet. The pace of change, however, need not be so languid. Certainly it will continue to require more cash, but first it must show that it can spend that cash wisely and efficiently.