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31-07-2011 | Article

The NHS numbers game

One of the difficulties in understanding the NHS and determining its future progress is its sheer size. Put bluntly, it is enormous and consumes large chunks of our national budget. For example, it employs 5.9% of the total workforce in this country, deals with 463 people per minute - and now needs to generate savings of £20 billion by 2014 (click here).

The thinking seems to be that if we do not control ever increasing financial demands, the continuous expected growth of the NHS over the next few years is unsustainable. The Secretary of State for Health Andrew Lansley has stated that by 2030 the health system as we know it will become unaffordable, an argument that could be used as justification for carrying out the proposed healthcare reforms. On the surface this seems reasonable - and is broadly the same argument put forward for the proposed pension reforms. If we do not tackle these problems now, they will become overwhelming for the next generation. The cost of reforming the NHS in England is a whopping £1.4 billion (click here), but the idea is to sort it out now before it becomes a runaway train.

However, it may not be as simple as that, according to an article published in the univadis GP News service (click here) quoting a short but well-written article in the British Medical Journal (click here). Of course predicting future trends can be tricky, especially 19 years in advance. However, by making some simple calculations and projecting reasonable economic growth until 2030, it is possible that the share of NHS spending in England could only be a little higher than it is now when expressed as a proportion of gross domestic product - which, to you and me, is a measurement of turnover of a country's revenue (click here for a more technical description). If that is the case, healthcare in 2030 will probably still be affordable based upon a number of assumptions.

This raises the dilemma of how much belt tightening to do now - too little and we could be building up problems for future years, whereas excessive cuts now could jeopardise health care for the population in the current and near future. We simply do not know how well the economy will grow or what the future costs of health care will be in this country, in addition to a number of other unknown variables. Nevertheless the BMJ article is an important contribution to the debate and adds another dimension. It also challenges political wisdom that the current trajectory of growth of the NHS is unaffordable.

Best wishes,


Dr Harry Brown, editor-in-chief univadis

Dr Harry Brown