Wednesday, 10 February 2016

In which we are reminded that the NHS management don't understand economics


It starts with this:

‘Collectively and cumulatively [these actions] and others like them will help shift power to patients and citizens, strengthen communities, improve health and wellbeing, and – as a by-product – help moderate rising demands on the NHS’

This is the rather ghastly sounding 'Health as a Social Movement' line in the NHS's vain attempts to pretend that preventative medicine will 'moderate rising demands'. What is most striking here is that, yet again, the basic economics of all this are overlooked (although given they've appointed the risible joke of a think tank, New Economics Foundation, it's pretty clear they're not remotely interested in actual real economics).

Unless the project is about improving productivity through these community-focused actions then the only impact - assuming they do improve health and wellbeing - will be to increase the long-term demands (and hence costs) on the NHS.

The report ...projected that people with Type 2 diabetes who participated in a disease management program to prevent serious complications would cost the federal government slightly more money over 25 years than they would have without any intervention.

If you stop and think about this for a second, the reason for a healthy community being more expensive is pretty obvious - most of the costs in the health system (and the care system too) are directed towards older people so if more people live to a ripe old age there are more of those 'end of life' costs.

To use a big example, we've seen a massive decline in the numbers of and in survival rates from heart attacks - since 2002 the mortality rate has more than halved. In simple terms this means there are double the number of long-term heart 'patients' compared to the old days when they all died of a heart attack. This absolutely brilliant and a credit to doctors, pharmacists and the health benefits of a bigger, richer economy. But it's costing the NHS a fortune.

And it's not just heart attacks but every sort of disease, from childhood infectious diseases through to cancers, that has seen declining mortality rates. And this means it's pretty normal to live into your 80s, not unusual to make it to 90 and increasingly common for folk to make it to 100. So when we act - quite rightly - to prevent disease and reduce mortality rates the result is more and more old people and more and more demand for the NHS services that are under so much strain.

The challenge for healthcare is to improve productivity - to reduce unit costs for operations, for providing care, for dispensing medicines, for all the vast array of stuff health care does. And spending money on "health as a social movement" only does this if it means that the allocation of NHS resources to these communities is thereby reduced. So long as we focus on simple prevention as a demand management tool, we will find no benefit in higher productivity and a pile more demand-led costs for the system.

This is, of course, what you get if you believe that NESTA, the RSA and New Economics Foundation are the sorts of organisations that are able to guide the NHS towards greater efficiency and higher productivity. A load of left-wing cant and absolutely no moderation of rising demand.


1 comment:

Anonymous said...

1 there have been many studies proving that living longer increases lifetime medical costs
2 the people pushing for lifestyle interventions know this and are not stupid
3 no reduction in medical costs despite interventions will be used to justify further interventions even though failure is inevitable.
4 politicians will agree through expediency, incompetency or corruption, taxes will be raised, laws will be passed
5 private health and big pharma laugh all the way to the bank
6 NHS buckles under the strain, both financial and structural.