Health,  Life

The Dilemma Facing Britain’s NHS: Soaring Demand, Limited Funds

At 7:00 am on August 11, 2023, junior doctors in the UK will start their fifth round of strike since March this year. The British Medical Association (BMA) stated that the strike is planned to last for four days, and the appeal is to improve wages and working conditions. .

Matthew Taylor, chairman of the British National Health Service (NHS) Federation, told the media that successive doctors’ strikes could cost as much as 1 billion pounds. The NHS is responsible for ensuring universal public health care in the UK.

As of August, 810,000 appointments and surgeries had been postponed because of strike action, a number that is likely to continue to grow. However, increasing financial investment and raising salaries for medical staff will put huge pressure on the finances.

Seventy-five years ago, Britain became the first major country to introduce “free healthcare” paid for by collective taxation. Providing uniform health care to all UK taxpayers is the UK government’s largest welfare expenditure, and the NHS has become a model for many other systems that, in the name of fairness and cost containment, have tried to remove the profit motive from healthcare.

It’s just that on how to get rid of the status quo, the British reformers have never reached a consensus.


A growing number of patients

In the view of a medical policy researcher, public hospitals in almost all countries have the problems of inefficiency and patient waiting, but the degree is different. The United Kingdom, which practices universal free medical care, has been facing the problem of low efficiency.

At the 2012 London Olympics, 600 actors dressed as doctors and nurses walked into the stadium, showing the dazzling “NHS” to the world. Over the years, the government-led “British model” has been imitated by many countries. Sweden, Russia, India, Brazil and other countries have established free medical systems.

Among 32 high-income countries in the world, the UK NHS ranks 10th in the 2021 World Index of Healthcare Innovation, which measures the quality of healthcare services, freedom of choice and access to new treatments, science Four aspects of technology and financial sustainability are investigated.

Only after the new crown epidemic, the original problems of British medical care have been further magnified. Doctors and nurses are dissatisfied with their income and working conditions, and the waiting time for medical treatment is getting longer and longer, consuming the patience of the public.

In the country of 66 million people, the NHS estimates that around 7.47 million people are waiting in the queue for specialist non-urgent treatment by May 2023, which covers diagnostic tests and scans, surgeries such as hip and knee replacements, Also includes heart surgery, cancer treatment and neurosurgery. Before the new crown epidemic, the number of queues was about 4.4 million.

These waiting people are all referrals. The NHS implements a hierarchical medical system. The first level is primary medical services under the responsibility of local executive committees, including general practitioners, dentists, pharmacists and ophthalmology. The government purchases services from private clinics to maintain high-quality services under “market” competition.

“One of the conditions for the implementation of free medical care is the need to implement grass-roots first diagnosis and graded diagnosis and treatment to achieve a reasonable allocation of medical service resources.” Hua Ying, an associate researcher at the Institute of Population and Labor Economics, Chinese Academy of Social Sciences, told “Finance∙Big Health” introduce.

That is to say, a strong grassroots medical and health service system is needed to play the role of “gatekeeper”. Hua Ying said that general practitioners are the foundation of the NHS in the UK. Patients receive services from general practitioners first, and general practitioners decide whether patients need to be referred to specialists. These general practitioners have undergone strict professional training, and their medical technology is popular among the public trust.

The second level is the hospital and specialist services under the responsibility of the Regional Hospital Committee, providing emergency, specialist outpatient and examination, surgery, hospitalization, clinical care and other medical services. Almost all of this level are public hospitals, and specialist doctors are national public officials.

Under the principle of “free for all”, the various expenditures of national medical care are paid by national taxation. Various inspections and laboratory tests in the hospital, as well as hospitalization, nursing, surgery, and medicines are all free of charge.

But now to enjoy this treatment, more than half of the patients on the waiting list of the hospital have been waiting for 18 weeks, and about 400,000 patients have been waiting for more than a year.

The NHS aims that 96% of non-urgent referrals should receive their first treatment within 31 days of being diagnosed with cancer. But after 2021, it will not reach 95% almost every month. By January 2023, this figure has even dropped to 88.5%, a record low.

The pressure of the emergency department is even more prominent. According to NHS figures, in February 2023, 43.2% of patients waited more than four hours for treatment in A&E. By April, it had eased, and the proportion of patients whose waiting time did not exceed 4 hours was 74.6%, but it was still far below the set target of 95%. The average wait time for an ambulance response was more than 1 hour and 30 minutes, compared to the target of 18 minutes. Among patients with heart disease, stroke, etc., 1 out of 10 people wait for an ambulance for more than 1 hour.

The Royal College of Emergency Medicine estimated in December 2022 that between 300 and 500 people died every week due to delays. British Prime Minister Sunak said that the top priority of the NHS now is to reduce the number of queues and allow patients to receive treatment as quickly as possible.

Although there are 21% more doctors and 16% more nurses in the UK than five years ago, the vacancy rate is still as high as 8.9%. The growth rate of the British medical manpower has not been able to meet the rising demand of the public.

Paramedics are increasingly fatigued, and by 2023 ambulance staff and nurses are on strike for the first time in 30 years to protest wages and working conditions. Junior doctors, senior doctors, consultants, etc. all arranged similar actions.

To avoid waiting lists, more and more people pay for private medical or health insurance out of their own pocket. Statistics show that in the second quarter of 2022, the number of patients directly paying for care in private hospitals in the UK increased by 34% compared with the same period in 2019, reaching 67,000.


Financial Dilemma

The result of the game at this stage is that Sunak, who had refused to increase the salary of medical staff at the beginning of the year, agreed to a salary increase of more than 6% on July 13, saying that this would be the final negotiation.

On August 11, however, junior doctors took to the streets. The current predicament of British medical care is mainly due to the long-term underinvestment in health services.” Chen Zengxi, a professor at the Nuffield Department of Population Health at Oxford University, recently published an article in the New England Journal of Medicine, although different experts weighed the contributing factors. Opinions vary, but there is substantial agreement on the causes of these crises.

The British media analyzed that: “The continuous degradation of the British medical service capacity is the root cause of the current crisis.” The newspaper quoted a research report by the British medical think tank Health Foundation and pointed out that the level of British health services has shown a “continuous decline” trend in the past 10 years .

According to the data from the National Bureau of Statistics of the United Kingdom, the expenditure on health care in the United Kingdom will be about 280.7 billion pounds (about 2.6 trillion yuan) in 2021, which is equivalent to an average cost of 4,188 pounds (about 39,177.11 yuan) per British person, which is higher than that of 14 European countries. The national median is 18% lower.

The UK government has struggled to rein in growth in health spending. Between 2000 and 2009, spending on the UK health system rose from 7.0 per cent of gross domestic product (GDP) to 9.8 per cent, according to World Bank figures. It has declined slightly since the introduction of the “austerity policy” in 2010 and stabilized at 10.2% in 2019.

This is already far ahead of many free healthcare countries. Chen Wen, School of Public Health, Fudan University estimated in his article that in India, Brazil, Russia and other countries, public health expenditure accounted for less than 4% of GDP, and India even accounted for only 1%. Cuba, the United Kingdom, Denmark, Sweden, Italy, Canada and other countries accounted for a relatively high proportion of government/public health expenditures, with Cuba accounting for 9.8% and Sweden accounting for 9.7%.

The gap in these data is reflected in the gap in the services covered by the free medical care provided by the state.

Free medical care in the UK covers almost all basic medical services, including cancer, dentistry, and assisted reproductive technology. India, which has the lowest proportion, has a free medical system, but there are very few public hospitals with financial burdens, and their functions can only treat people’s daily fevers and colds. Some people have to go to private hospitals at their own expense for serious illnesses.

The UK has been insisting on running a “just in time” system to reduce expenditures, that is, to improve the efficiency of hospital bed utilization. From 2010 to 2011, the number of overnight hospital beds per 1,000 people decreased by about 10%, and the number of day beds increased by about 13%. The problem is that between 2009 and 2019, available beds in regional hospitals in England and Wales fell by 8.3% and 14.9%, respectively, according to data published by the British Medical Journal.

In addition, there are 1,800 fewer GPs in the UK than in 2015. Due to the inability to obtain follow-up nursing support, a large number of patients who meet the discharge standards have to continue to occupy hospital beds, resulting in the inability of emergency patients to come in, the backlog of patients in the diagnosis and treatment process, and low service efficiency.

Although the British government has increased health spending during the new crown pandemic and has stepped up again in recent months, there are still voices calling for more financial investment to reduce waiting lists for consultations.

“We are relearning the lesson that the effects of a decade of underinvestment cannot be reversed quickly,” Chan said.

Over the past 10 years, real salaries for junior doctors have fallen by more than 25% and nurses by about 10%, leading to early retirement and resignation for nurses.

The British Medical Association (BMA) joked in a news release that “it is better to save one more patient than to make an extra cup of coffee”. The salary of a junior doctor in the UK is now £14.09 an hour, compared with the hourly wage of a barista It was £14.10.

A junior doctor says he has racked up more than £100,000 in debt during his training as a medical student and is still relying on his mum to pay off credit card debts even though he is working. This is not only a disgrace to him, but also an injustice to the mother.

Brexit has reduced the inflow of European medical professionals, especially nurses. They originally accounted for a considerable proportion of the British medical system. As of June 2022, 33% of doctors in the UK are not British nationals.

The government plans to train the country’s medical staff as quickly as possible, with the latest plan showing doubling the number of medical school training places to 15,000 by 2031 and adding more places in areas with the greatest shortage. Increase the number of GP training places by 50% to 6000 by 2031.

However, this plan will take several years to implement new staff. The short-term response of the British government is to introduce health workers from low-income countries, such as India, Pakistan, Egypt and so on.

The British government, on the other hand, sees NHS workers’ wage demands as an inflationary cause and has repeatedly said it will not raise taxes or borrow money to fund the NHS.

Limited funds are difficult to solve the demands of medical care. British Prime Minister Sunak also said that he “would like to give nurses a substantial salary increase”, but the government is now facing a difficult choice. Because money is being pumped into other parts of the NHS, such as buying more medical equipment and ambulances.

This also confirms that in the above-mentioned World Healthcare Innovation Index rankings, the UK’s financial sustainability score is the most obvious shortcoming, ranking 24th among 32 high-income countries.

The NHS is the poster child for a system that at one point tried to remove the profit motive from the delivery of care. Chen Zengxi believes that the current predicament is really painful for patients and frustrating for medical staff. Other countries in the world should also care about this issue.

What can I do? In December 2022, the Royal College of Nursing, Britain’s largest nurses union, organized its first strike since its founding 106 years ago. In June this year, junior doctors in the UK plan to go on strike for 3 days, and in August, junior doctors in the UK will take to the streets for the fifth time.

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