HAPPY 70TH BIRTHDAY NHS
On 5th July 2018, we said Happy Birthday to the National Health Service. It’s been 70 years since Nye Bevan changed the face of healthcare in the UK, offering a service that was free for all at the point of delivery. The NHS has become the largest public-sector employer in the UK, with around 106,000 full time doctors, and 286,000 nurses and health visitors – alongside thousands of other staff members. As of July 2017, there were 207 clinical commissioning groups, 7,454 GP practices, and 10 ambulance trusts.
Ipsos MORI state that, in 1948, 75% of the public thought the NHS was a good thing – now 87% of us do. As a society we value our health service, which is why its sustainability is so vital.
AN UNSUSTAINABLE SYSTEM
Every 36 hours, over 1 million people are seen by the NHS, and the UK government spends roughly £150 billion on health every year. Public spending on health has increased throughout the NHS’s 70-year history – starting out at 3.5% of national income in 1949-50 and rising to 7.3% in 2016-17. George Stoye, the author of a 2018 report for the King’s Fund, states that ‘we spend twice as much on health today as we did 20 years ago’. The system is currently unsustainable, and efforts by bodies such as the Sustainable Development Unit are attempting to come up with an answer to the problem.
Debates over how to improve sustainability and curtail NHS spending clearly are not new, but if the health service is to serve us for another 70 years then the key to sustainability must be found.
One potential avenue we could follow is by improving innovation in the life sciences sector. This article will look at the NHS’ current efficiency and sustainability problems and identify whether or not life sciences could reduce spending and improve the life span of our nation’s health service.
LORD CARTER’S EFFICIENCY REPORT
Ipsos MORI found that 50% of the public currently think that the NHS wastes money. This opinion was also voiced in 2016, through Lord Carter of Cole’s report into operational productivity and performance in English NHS acute hospitals for the Department of Health.
Lord Carter noted that the NHS has ‘some of the best hospitals in the world, in terms of both quality and efficiency’ but that £5bn could be saved by reducing ‘unwarranted variation’ across hospitals.
Notable inefficiencies included different costs of inpatient treatments, variation of deep wound infection rates across hospitals, varying procurement costs for the same products, higher staff sickness and absence rates in some trusts, and huge variations in facilities running costs.
IMPROVING SUSTAINABILITY WITH LIFE SCIENCES RESEARCH AND TECHNOLOGY
Some of the inefficiencies identified in this report are the responsibility of management, HR and other departments, whilst others could be improved by innovation in life sciences. For example, procurement.
Lord Carter states that the ‘average price paid for hip prosthesis varies from £788 to £1590, and trusts buying the most are not paying the lowest price’. This could partly be improved through uniform costings and forging better deals with suppliers, but research can also help to reduce the costs of these products in the first place.
He indicates that innovation in industry and life sciences research and development could help NHS trusts to cut costs. Procurement costs could be reduced by the development of better, smarter, and more cost-effective technology, which would improve sustainability at the same time as improving patient care.
NHS England themselves celebrate the 2017 life sciences sector deal and their relationship with the life sciences sector, saying that they want to create an environment where ‘technologies can be developed and tested, and used to transform services to improve outcomes and reduce cost’.
Sophie Castle-Clarke, writing for The King’s Fund, offers a similar viewpoint towards innovation and efficiency, citing advancements in genomics and precision medicine. She argues that innovation in technology could ‘deliver significant savings’but the NHS needs to get better at implementation of technology for it to make a difference to sustainability.
Lord Kakkar also champions innovation in life sciences but does not see this as the only key to NHS sustainability. In January 2018, he suggested that ‘the delivery of healthcare in our country is not going to be sustainable unless we are able not only to adopt innovation to make the delivery of healthcare more effective in improving clinical outcomes but to use in the most efficient fashion the vital and valuable resource that the state makes available for the delivery of healthcare’.
This suggests that whilst innovation in the life sciences sector could be key to NHS sustainability, it will only be so if its outcomes are implemented properly into NHS processes and the resources that are provided to the NHS are used efficiently.
COULD LIFE SCIENCES INNOVATION DAMAGE NHS SUSTAINABILITY?
Whilst life sciences innovation could be seen as key to cost cutting, the other side of the argument sees it as a drain on NHS resources, creating ever more procedures and technologies that could benefit patients, but have to be paid for.
January 2017’s Fiscal Sustainability Report from the Office for Budget Responsibility suggested that public finances are under pressure for three reasons. An aging population demanding more from the health service, the increase of chronic health conditions, and the increase in technological advancements that mean we can do more (and therefore, do do more) to treat complicated health problems. The report says that technological advancements, which are often made possible by research in life sciences, are going to ‘remain important drivers of spending in the future’.
There are not only questions over life sciences research making the NHS less sustainable because of current costs, but also because of the depletion of natural resources in the future. The Sustainable Development Unit takes the examples of nanotechnology and genetic therapy, using them as an example of innovative technologies that would potentially be unsustainable in the ‘carbon-constrained’ future of the NHS.
DOES LIFE SCIENCES HOLD THE KEY?
Advancements in technology and breakthroughs in healthcare research make new realities possible. The life sciences sector does absolutely help the NHS to provide better care, and new treatments, to patients. In the short term, these advancements are expensive – although the argument that they could damage NHS sustainability is quietened somewhat by NICE’s commitment to sustainable healthcare.
Whilst some advancements remain expensive, many innovations in life sciences help the NHS to cuts its costs and increase efficiency. Better treatments mean that patients are in and out of hospital quicker and are often less likely to return. This indicates that continued innovation in this sector is key to NHS sustainability – but only if it is implemented properly and coupled with improved efficiencies across the whole system.
Life sciences is an important key, but it is not the only one.