Where does all the NHS money go? A 💈
Constant wrangling over NHS finances: it’s a bottomless pit - it’s mismanaged - it’s a huge amount - it’s not enough - will never be enough....
Where to start with all of this?
Let’s take a look....
1/15
Constant wrangling over NHS finances: it’s a bottomless pit - it’s mismanaged - it’s a huge amount - it’s not enough - will never be enough....
Where to start with all of this?
Let’s take a look....
1/15
Does UK spend match comparable countries?
Well no. Not in proportion of national income or per head of population, it spends less than average
In comparison to G7 countries it’s spend was second lowest
2/15
Well no. Not in proportion of national income or per head of population, it spends less than average
In comparison to G7 countries it’s spend was second lowest
2/15
UK does spend a huge amount on healthcare
However it’s no more and in fact less than comparable countries
Fact 1: In order to have good healthcare - we have to pay for it
3/15
However it’s no more and in fact less than comparable countries
Fact 1: In order to have good healthcare - we have to pay for it
3/15
Has UK spend changed over time?
Yes
Until financial crash 2008 NHS received annual uplift of approx 3.7% since its inception
After 2008 reduced to 1.4% and stayed at this level till 2019
Fact 2: Spending has reduced in real terms since 2008
4/15
Yes
Until financial crash 2008 NHS received annual uplift of approx 3.7% since its inception
After 2008 reduced to 1.4% and stayed at this level till 2019
Fact 2: Spending has reduced in real terms since 2008
4/15
Comparable countries have not reduced spend, many have increased it in recognition of population growth/ patient demographics
And acknowledgement that better population health is essential for economy and well being
5/15
And acknowledgement that better population health is essential for economy and well being
5/15
What does the money go on?
Well essentially salaries, medicines, equipment, buildings....
Interestingly we have markedly less qualified staff
Less doctors, nurses, allied health professionals such as physios
2.6 doctors per 1000 compared to 3.6 per 1000
6/15
Well essentially salaries, medicines, equipment, buildings....
Interestingly we have markedly less qualified staff
Less doctors, nurses, allied health professionals such as physios
2.6 doctors per 1000 compared to 3.6 per 1000
6/15
We have less hospital beds. Since 2010 we have lost 16000 beds, including over 5000 acute and 6000 mental health beds
2.6 per 1000 compared to 4.5 per 1000 average
Fact 3: We have less qualified staff and less beds from our funding
7/15
2.6 per 1000 compared to 4.5 per 1000 average
Fact 3: We have less qualified staff and less beds from our funding
7/15
Proportion of funding spent on private providers is approx 26%.
Not transparent and hidden according to recent 6 year review.
Lack of transparency = impossible to understand if value for money and where money in system is going
Services or profit?
8/15
Not transparent and hidden according to recent 6 year review.
Lack of transparency = impossible to understand if value for money and where money in system is going
Services or profit?
8/15
1 in 3 NHS funded hip replacements now take place in private hospitals
As do 27% hernia repairs and 20% cataract procedures
Compares with almost none in mid 2000’s
What changed?
2012 Lansley reforms accelerated private provision
9/15
As do 27% hernia repairs and 20% cataract procedures
Compares with almost none in mid 2000’s
What changed?
2012 Lansley reforms accelerated private provision
9/15
Lansley opened door for provision of private services such as GP surgeries, out of hours services, urgent care and minor injury units, diagnostics, maternity care, elective surgery, community nursing,ambulance services, prison health, wheelchair services and more...
10/15
10/15
Private provision even extended to running of whole hospitals
Fact 4: Not possible to fully understand health care spending unless transparency around private provider input is provided
11/15
Fact 4: Not possible to fully understand health care spending unless transparency around private provider input is provided
11/15
UK healthcare spending to date not marred by conflict of interest
For example: is it in the interest of the patient or the provider to order tests, referral, intervention?
More tests/ referral/ intervention = more profit?
12/15
For example: is it in the interest of the patient or the provider to order tests, referral, intervention?
More tests/ referral/ intervention = more profit?
12/15
This is US style healthcare
Potentially happening right here. Right now.
Fact 5: Significant funding allocations to private providers are taking place under banner of NHS Logo
13/15
Potentially happening right here. Right now.
Fact 5: Significant funding allocations to private providers are taking place under banner of NHS Logo
13/15
So back to original questions:
UK spends no more and in fact less than comparable countries
Lack of transparency on this spend makes it difficult to evaluate value for money
Major transparency issues around private provider contracts now making up 26% of total budget
14/15
UK spends no more and in fact less than comparable countries
Lack of transparency on this spend makes it difficult to evaluate value for money
Major transparency issues around private provider contracts now making up 26% of total budget
14/15
Bottomless pit? Not on this data
Enough resource? Not on this data
Mismanaged? Difficult to know
Where is money going in private providers?
How much profit now being made that is not being used for patient care?
Ends
15/15
Enough resource? Not on this data
Mismanaged? Difficult to know
Where is money going in private providers?
How much profit now being made that is not being used for patient care?
Ends
15/15
References in thread below 👎👎
https://twitter.com/sallymi83941850/status/1460949453574131723
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