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Cheer up – we’ll soon be back on the road to disaster

 

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Friday, 9 December 2011

Cheer up – we’ll soon be back on the road to disaster

One hundred and sixty five mile an hour winds ripped through a rain-lashed Scotland yesterday and the lights went out in thousands of homes.

Last night, the leaders of the European Union sat down to dinner at the most critical point in the region’s history since the European Economic Community was formed more than 50 years ago.

In Greece, the country that has come to symbolise the fears of the rest of Europe, there are growing queues at soup kitchens and the health system is nearing collapse. People are selling scrap metal out of shopping trolleys to make ends meet. Soon they’ll be selling the trolleys. 

Right-wing groups are gaining ground, looking for someone to blame. The most that can be said for these events is that they make our own problems easier to bear, except of course they are our problems too. The winter weather will inevitably head south and if the weather has a sense of humour it will chuckling at the prospect that record numbers of people can’t afford to heat their homes.

The economic weather is on the move too. Sterling will be useless as insulation if the Euro melts. British banks are heavily exposed to their European neighbours. Another banking crisis is looming.

But none of this matters much. However it goes, it will turn up in the end. A few years of austerity and we will be back at the top of the economic cycle and back on the road.

We have grown so used to this pattern that we believe it is endlessly repeatable, but it isn’t.

Marx and Engels argued that capitalism would collapse under its inability to sustain ever increasing production, but then they hadn’t reckoned on the iPod, the disposable nappy and Sky TV. With no end in sight and an endless supply of things to consume, the point at which an angry proletariat rises up and seizes the means of production just keeps receding.

There will be a conclusive economic disaster; it’s just a little way off. It won’t be the result of failing factories but of failing hospitals. It will happen because the cost of healthcare will become unsustainable.

One in six babies born today will reach 100. Last year, life expectancy increased by a record 44 days – that’s a rate of very nearly a day a week.

People live longer but also spend longer living with poor health. A recent analysis of more than 1m medical records in Scotland showed that people over 65 had on average two long-term conditions, and those over 75 had three. The figures were quoted by Sir John Oldham at in a speech at the NHS Alliance conference last week. By 2050, the number of people over 65 living with one or more chronic conditions will have risen by 252%. “People with co-morbidity are the core business for health and social care,” Sir John said. “The mathematics are inescapable.”

One of the reasons they are inescapable is that Sir John keeps repeating them, but that doesn’t make them any less shocking.

Longer life is not the same as better health. Health is not improving at anything like the same rate as treatment of illness, and it’s the treatment that costs the money – the drugs, the clinical procedures, the buildings and the vast workforce.

It is also inescapable that we have to use less of all these things to make the whole enterprise sustainable, but just cutting back won’t solve the problem. 

Between 1960 and 2008, the cost of healthcare in the UK more than doubled as a percentage of GDP – the only real terms that count. The graph is strikingly similar for countries such as Japan, Germany and the US, suggesting that longer life and rising health costs are global problems that transcend differences of structure, organisation and philosophy in developed health economies. To put it another way, reorganising things or saving the odd £20bn won’t help.

David Flory, the NHS deputy chief executive and the sort of fellow whose hand would put the most unsteady of tillers at ease, describes the NHS funding situation in less dramatic terms than Sir John. 

During a speech which included the reassuring news that there was “non recurring headroom in the totality of the PCTs’ allocation”, Mr Flory made it clear that the “demands on the system significantly outstrip growth in resources”. This is probably as close as he ever gets to cursing. 

He was asked about the possible impact of the imploding Euro on his forecasts for the NHS. That, Mr Flory said, was out of his hands, a matter for Treasury. 

He said it in the same calm manner in which a ship’s captain might explain the imminent rocks as a matter for the coastguard.  

 

 
SJBurnell
SJBurnell says:
Dec 09, 2011 10:42 AM
Agreed, simply cutting won't resolve the problem because it does not address demand.

We need to redesign what, where, how, when, & why services should be provided & who needs them & who should deliver them. For example, we need to spend more on Dementia Services if we want to reduce overall costs.

We need to model what a single locality would look like if it were designed to achieve success against the 60 new Indicators & deliver optimum performance against the Atlas of variation.

'Perfect' is probably unaffordable, but would it not be useful to know what 'optimum' looked like:
How much investment upstream is needed & where to put it?
How much will be released downstream & who must save it?
What services/eligibility changes need to be made?
What incentives need to be introduced/realigned?
What are a Patient's own responsibitities?
How much more/less would it cost overall?
What are the time-lags in Public Health?
How long would it take?

I'm sure the NHS & Local Government could do this at an appropriate level of detail to give robust guidance.

The intelligence & tools exist, but a new model of thinking is needed for real change - we just need the will.
s.cribb@nhs.net
s.cribb@nhs.net says:
Dec 09, 2011 11:04 AM
A depressing reality check but true and incisive as always. Longer lives = more demand = more cost, simple. If we do not focus on "healthy lives" then the whole NHS system is unsustainable no matter what state the ecomony is in. Why should a "tax the polluter" strategy be OK to protect the planet yet a "tax the killers" strategy be so unacceptible when it comes to protecting our people. Quite simply we MUST take control of unhealthy lifestyles... and sorry, brightly coloured posters and adverts just don't cut it! Now, this is from a fat bloke who likes crisps and chocolate... but i'd not pay £2 for a Mars bar or bag of crisps so there you are...that's how you stop ME from killing myself. Its time to control demand through taxation and price increase with the revenue directly fed into health and prevention. The same goes for alcohol and when it comes to drugs, well don't get me started! ... but we simply MUST seize control of these and get them out of the hands of criminals no matter how impalatable the options might seem.
rick.molton@bristol.nhs.uk
rick.molton@bristol.nhs.uk says:
Dec 16, 2011 09:33 AM
Why is that everytime there is an 'issue' the answer is to increase the price or raise the tax? The last Liebour government had this approach. I smoke and have yet to hear of any friends giving up smoking because the price has gone up. The 'educating' of the masses takes time and is a gradual process; smacking their wrists does not work. If you cannot say no to a sweetie or two, why should I have to pay more?
Bipper